By David Gorn, California Healthline
State officials on Friday said they have not determined whether or not to offer applied behavior analysis (ABA therapy) as a Medi-Cal benefit to children with autism.
Federal officials earlier this month issued guidance on the subject, saying it is covered for Medicaid beneficiaries under age 21 as part of the Early and Periodic Screening, Diagnosis and Treatment program.
“Under the Medicaid state plan, services to address [autism spectrum disorder] may be covered under several different … benefit categories,” the CMS guidance said. For children, it said, “states must cover services that could otherwise be covered at state option under these categories consistent with the provisions … for Early and Periodic Screening, Diagnostic and Treatment services (EPSDT). Continue reading
By David Gorn, California Healthline
CMS officials released federal guidance for states on Medicaid coverage of autism therapy on Monday, and that guidance indicates it is covered for beneficiaries under age 21.
“ABA therapy must be covered (by Medi-Cal). It’s very, very clear.”
“It’s a good day. It’s such a good day,” said Julie Kornack, senior public policy analyst at the Center for Autism and Related Disorders, an advocacy group based in Tarzana. “Whenever you get a decision that we’ve been seeking for years, that is a good day.”
Applied behavior analysis treatment, known as ABA therapy, now is a benefit for those under age 21 under the Early and Periodic Screening, Diagnosis and Treatment (EPSDT) provision of Medicaid — and therefore it also must be covered under Medi-Cal, California’s version of Medicaid, according to Kristin Jacobson, president of Autism Deserves Equal Coverage, an advocacy group based in Burlingame. Continue reading
By David Gorn, California Healthline
CMS officials last week approved a state plan amendment for the state of Washington that includes autism therapy as a Medicaid benefit.
It’s the second state in a month to receive that go-ahead from the federal government, and it means autism coverage should be a Medi-Cal benefit in California, as well, according to Kristin Jacobson, president of Autism Deserves Equal Coverage, a not-for-profit autism advocacy group.
The budget passed this week by the California Legislature omitted autism therapy as a Medi-Cal benefit.
Autism advocates hope one day soon CMS will make it clear that applied behavior analysis treatment — known as ABA therapy — should be a required benefit for all states receiving Medicaid, including California. Continue reading
Every two years, the federal government announces the rate of autism. This is what NPR’s shots blog had to say about today’s numbers, which show 1 in 68 children in the U.S. have an autism spectrum disorder.
That’s a remarkable jump from just two years ago, when the figure was 1 in 88 and an even bigger jump from 2007, when it was just 1 in 150.
But officials at the Centers for Disease Control and Prevention officials say the agency’s skyrocketing estimates don’t necessarily mean that kids are more likely to have autism now than they were 10 years ago.
“It may be that we’re getting better at identifying autism,” says Coleen Boyle, director of the CDC’s National Center on Birth Defects and Developmental disabilities.
For one thing, the prevalence seems to vary in different communities and among children of different races. The CDC found white children are far more likely to be identified with autism, even though scientists don’t believe the rates are truly different between whites, Hispanics or blacks.
“What we need to focus on is getting more people identified so they can get the supports they need,” Shannon Rosa, Bay Area parent advocate.
That means that the discrepancy lies in the diagnosis and services available in different communities. The shots blog points out the work of George Washington University anthropologist Roy Richard Grinker.
Along with other researchers, he studied autism prevalence in South Korea. They found that 1 in 38 children there met the criteria for autism spectrum disorder. Grinker thinks that the US number is likely closer to the one they saw in South Korea. Which means that in two years the CDC estimate will likely tick higher still.
By David Gorn, California Healthline
A recurring theme at the annual California Association for Behavior Analysis conference starting today in Burlingame likely will be the new definition of autism in the medical community.
Does the new designation make it harder to get a key treatment covered?
The national guidelines for doctors and other clinicians was updated last year. DSM-5 is the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, put out by the American Psychiatric Association.
In DSM-5, there is a new category in the autism spectrum — social communication disorder, or SCD. Since there are no clinical guidelines for treating SCD, autism advocates worry the new designation could be used by insurance companies to stop covering applied behavior analysis (ABA therapy) in treating autism disorder.
“It’s likely a small percentage [of SCD children among those with autism spectrum disorder], but it definitely will affect some people,” said Karen Fessel, director of the Autism Health Insurance Project. “There are no guidelines put out by insurance companies yet, so likely there will be no adjustments till October this year.” Continue reading
We all know air pollution is not great for your health, but two new studies this week stressed just how bad it can be for children, infants and the developing fetus. Exposure to air pollution at a young age, these studies showed, can lead to an array of long-lasting health problems, including asthma and autism.
It’s not just that polluted air can, say, trigger asthma attacks. Now, researchers are finding that exposure to air pollution may actually cause some diseases.
“We’re discovering some of the long-term effects of this air pollution: things like lung development in kids,” said Georges Benjamin, executive director of the American Public Health Association.
“Communities should be informed of what they’re breathing.” — Paul Cort, Earthjustice
led by UCSF found that African American and Latino infants living in communities with high automobile exhaust are more likely to develop childhood asthma than those living with less pollution. This is significant because minority communities are more likely to live near congested roadways.
In California, African Americans and multi-racial people have some of the highest rates of asthma, according to the CDC. But rigorous scientific studies that examine just how the lungs of minority children develop when swamped with car exhaust have been rare. Continue reading
By Ryder Diaz, KQED
If you don’t have a child with autism, you might not know about Applied Behavioral Analysis. ABA is widely regarded as a necessary and effective treatment.
Now many poor children will lose access to this therapy under deals reached in Sacramento last week. Meanwhile, other kids — including those who become insured under the state’s new Obamacare marketplace — may well continue to have access to this therapy.
Here’s the background: under the Affordable Care Act, states can expand Medicaid, called Medi-Cal in California. People with incomes up to 138 percent of poverty will be eligible. Last week, as the legislature and the administration were wrapping up the state’s budget, the legislature was simultaneously moving forward on final bills to implement the Medi-Cal expansion.
Last Friday, after months of debate, legislators sent two final bills to the governor’s desk to approve the expansion. But for supporters of the expansion, this victory came at the cost — ABA therapy for kids on Medi-Cal was axed. Children’s advocates are frustrated. Continue reading
New emergency rules won’t let insurers illegally limit therapy visits.(shannonrosa/flickr)
California regulators have issued emergency regulations aimed at keeping insurance companies from delaying or denying coverage for autism treatment.
Insurance Commissioner Dave Jones announced the approval of emergency rules this week, which take effect immediately.
“Autistic children and their families should now, without delay, receive the transformative treatment that will enable them to succeed in school, their families, and communities,” Jones wrote in a statement.
Insurers have already been required to comply with medically necessary treatment by the state’s Mental Health Parity Law and SB 946, which reinforced the mandate for private insurers to provide behavioral treatment for autism.
However Karen Fessel, executive director of the Northern California-based Autism Health Insurance Project, says these emergency regulations were needed.
“This is an example how even with the right laws in place you still need vigilant regulators who will help interpret the law in ways that they were intended,” says Fessel “Because the health plans often twist things around so much people don’t get the care they need even with the laws.” Continue reading
Hispanic children have had a lower rate of autism than other children — although their cases tend to be more severe. Researchers had wondered — is there something protective about being Hispanic? Or is this a case of lack of access and lack of understanding of warning signs?
I think you can guess the answer. But proving it is generally better than guessing.
In one of the largest studies so far to compare development in Hispanic children and non-Hispanic children, researchers at the UC Davis MIND Institute wrote that Hispanic children “displayed more similarities than differences compared to non-Hispanics.” In the case of autism, they found that rates of autism were actually roughly the same between Hispanic and non-Hispanic children.
The study’s lead author, Virginia Chaidez, Ph.D. said the research filled in a piece of “large puzzle” and added “autism is a spectrum and it’s very similar across the board. So we’re pretty confident in promoting outreach and trying to encourage the Hispanic community to learn the signs very early in life.” Continue reading
By Kamal Menghrajani
It was news that startled many. A new study from the Centers for Diseases Control and Prevention suggests that the prevalence of the disorder is much higher than previously thought. Up to 1 in 88 children is expected to develop autism or a related disorder, which is a 23 percent jump from the rate the CDC found just 2 years ago. Perhaps one million children and teens across the country are affected.
This morning on KQED’s Forum, autism experts discussed the significance of the new numbers and what progress is being made in the field of autism research.
The first question on everybody’s mind was whether the new number represents a true rise in the rate of autism – or is simply a reflection of the fact that more doctors are recognizing it.
“We’re not sure what the increase is due to. We do know that better identification, better diagnosis, and availability of services is contributing,” said Coleen Boyle, Director of the National Center on Birth Defects and Developmental Disabilities at the CDC. Continue reading