SEA-TAC, Wash. –The Health Technology Assessment committee is an independent panel of 11 practicing health care professionals who make coverage decisions for state-funded programs. Using independent clinical evidence, the HTCC determines if certain procedures or technologies are safe, effective, and cost-effective.
The committee’s decisions are used to determine whether the procedures will be covered under public-funded health coverage in Medicaid, state employee health benefits, worker compensation or other state-purchased health care. A HTA Clinical Committee met on Friday afternoon to review Applied Behavior Analysis as a Health Technology for treatment of autism. 46% of all children born in WA are Medicaid recipients, 18% of all WA employees have public benefits. This was a very broad reaching review.
Prior to the meeting the committee had found that:
- Most of the reviews generally concluded that the evidence base for EIBI (Early Intensive Behavior Intervention) is inadequate, noting: unacceptable variability in treatment and intervention limited follow up, lack of comparative studies and need for replication, and unclear inclusion and exclusion criteria.
- Other areas for improvement noted included a need for larger sample sizes; longer follow-up to allow for evaluation of the durability of effects; greater treatment fidelity; improved reporting of methodological and participant characteristics; and greater consistency in treatment approaches and outcomes measurement.
The Agency Medical Director Dr. Jeff Thompson had recommended:
- The science for ABA types does not have a sufficient base to justify a $29-50K benefit
- He asked the committee to not recommend ABA type of therapies as a covered benefit
- He recommended better promotion of existing benefits such as early periodic screening and diagnostics to pediatric and Primary Care Physicians.
At the review committee meeting Dr. Bryan King of Seattle Children’s Hospital Autism Center testified to the efficacy of EIBI and offered to collaborate with the agency to develop guidelines to maximize efficacy while maintaining cost containment.
Arzu Forough testified on the lack of appropriate and effective healthcare for core symptoms of autism in children of all ages as well as the challenges facing medical and clinical experts that families turn to for help:
“Every year we & others like us across the state have gone through the same arduous process with medical panels who could not wrap their minds around a treatment for a neurological disorder that was not a pill, a potion, an elixir or a surgical procedure. In the absence of timely and evidence based intervention, throughout the state patients are suffering and dying.”
Dr. Sara White PhD BCBA-D of Bellingham’s Sendan Center testified on the scientific flaws and limitations of the HTA review process. She further testified children and adults who don’t receive treatment experience aggression and self-injurious and often debilitating behaviors that are routinely mitigated successfully and humanely through behavior analytic treatment.
Dr. Ilene Schwartz PhD BCBA-D testified to the rigor in education and training of Behavior Analysts and further reinforced the history of efficacy of EIBI for treatment of patients of all ages with ASD’s.
After hearing the public comments, the panel had a lot of unanswered questions and comments, were perplexed as to the challenges in this particular review and were clearly divided and had mixed reactions as to what they were tasked with. But one thing was clear to them at the end, they couldn’t in good conscience vote against the insurance coverage.
- ABA was recommended for coverage with the condition that some entity like UW Autism Center or Seattle Children’s Autism Center or both evaluate the data from the therapies provided. They want to ensure evidence demonstrates benefit.
- Conditions will be ironed out in collaboration with Seattle Children’s Autism Center & UW Autism Center. The members want to make sure there’s adequate oversight to ensure efficacy and fidelity.
FOR ADDITIONAL information review: HTA ABA review meeting materials
- Visit the Health Technology Assessment website at www.hta.hca.wa.gov
- Jim Stevenson, Communications, 360-725-1915 (Pager: 360-971-4067)
- Sharon Michael, Communications, 360-923-2764