Neurodevelopmental and Behavioral therapies’ exclusions in the Self-Funded plans

WAAA-LOGOIf your child or children are:

  • insured through a large employer that is self-insured (i.e. coverage through private (for-profit or nonprofit) employer including cities or counties), and
  • they have been denied medically necessary neurodevelopmental therapies (i.e. Speech Therapy, Occupational Therapy) or behavioral therapy (i.e. Applied Behavior Analysis)

WAAA would like to hear from you at your earliest convenience, please call 425.894.7231 with the following information:

  • your employer’s name
  • the type of treatment that is prescribed, but denied or unreasonably capped
  • name of the insurance company that manages your benefits

Please forward this note to any parent whose children may be in a similar situation.

Thank you for your consideration.

 

Mira Posner
Attorney
Washington Autism Alliance & Advocacy
16225 NE 87th St. Ste. A-9
Redmond, WA 98052
Phone: 425-894-7231
Fax: 206-299-3661

Health Care Authority Approves ABA Therapy for Medicaid Eligible Children

For Immediate Release: 11/01/2012

Contact:

MaryAnne Lindeblad, Director, HCA, 360-725-1040; Gail Kreiger, Manager, MedicalBenefits/Clinical Review, 360-725-1681;  Scott Crain, Staff Attorney, Northwest Justice Project 206-464-1519 x 258; Catherine Hoover,  Assistant Attorney General, 360-586-6477

Contacting Medicaid about autism

Parents and providers can contact Apple Health for Kids with questions or information aboutautism and Applied Behavior Analysis by emailing aba@hca.wa.gov.

OLYMPIA – Washington State’s Health Care Authority has settled a lawsuit brought by the Washington Autism Alliance & Advocacy over coverage of Applied Behavior Analysis therapy,also known as ABA, for children diagnosed with autism or conditions classified as autismspectrum disorders.

The settlement was approved by U.S. District Court Judge Richard A. Jones. EffectiveJanuary 1, 2013, the therapy will become part of the regular benefits in Apple Health for Kids,which includes all Medicaid children.

This benefit will be available to children enrolled in the Apple Health for Kids program belowthe age of 21 who have a variable range of difficulties with verbal and non-verbal communication, social interactions and repetitive behaviors. A trained ABA therapist can analyze a child’s behavior in response to the child’s environment, then use ABA therapy to change the child’s behavioral response.

“Recent evidence shows that this therapy has been effective and deserves to be covered byour benefit structure,” said MaryAnne Lindeblad, Health Care Authority Director. “This iswonderful news for Medicaid parents and entire families who have had little recourse in thepast in dealing with an autistic child. Too often, they were forced to extreme measures – evenleaving the workforce to stay home or forgoing treatment because its cost was beyond anordinary family’s means.”

“This settlement ensures children with autism and related disabilities have meaningful accessto remediation of their condition, regardless of their funding sources” said Arzu Forough, Chief Executive Officer of Washington Autism Alliance & Advocacy. “This is a turning point for low incomeWashington families involved with autism who have no other means of accessingmedical treatment for their children. With HCA’s leadership, we are entering a new era ofmeaningful access to evidence based treatment through Apple Health for Kids.”

While the Health Care Authority expects to gain approval on ABA coverage from the Centerfor Medicare and Medicaid Services in January, it is working to extend interim ABA servicesto children until that time.

Gail Kreiger, a Registered Nurse and manager of Health Care Authority’s Health CareBenefits and Utilization Management Office said, “Although the coverage change is effectiveon January 1, we are working with families of the children who have already been diagnosedand will help them navigate the pathway-to-care now. “Our first step will be to confirm thatfinding through a comprehensive evaluation by a Medicaid clinician who specializes in thediagnosis and treatment of autism; in a second phase, we will work with parents and ABAtherapists to obtain a functional assessment of the child’s condition and a treatment plan.”

Kreiger said approximately 9,000 children on Apple Health for Kids are at that initial stage ofidentification.

The Northwest Justice Project, a statewide legal aid program, represented the plaintiffsthrough its Medical Legal Partnership and worked with the state to mediate a comprehensivesettlement to assure access to ABA therapy for all eligible children.

The Health Care Authority recently entered a similar agreement to extend ABA coverage tostate and other government employees and their dependents who require ABA services.Providers who want more information on the ABA benefit or to identify a child with autismenrolled in Apple Health for Kids can contact the Health Care Authority via a special webpage at http://hrsa.dshs.wa.gov/abatherapy.

Clients were being notified by mail this week of the pending benefit change.FOR

MORE INFORMATION OR BACKGROUND:

  • News release on UMP benefit change: www.hca.wa.gov/news_release/publicemployees-enrolled-in-the-uniform-medical.html
  • HCA’s autism website: http://hrsa.dshs.wa.gov/abatherapy
  • Email address for parents and providers to contact HCA: aba@hca.wa.gov
  • HCA’s news release archive: www.hca.wa.gov/news_releases.html

Jim Stevenson, Communications, HCA 360-725-1915 jim.stevenson@hca.wa.gov