Saturday, February 7, 2009

More About Wisconsin Autism Insurance Legislation

NOTE: For more information, including links to all my posts on autism insurance in Wisconsin, visit Wisconsin Autism Insurance - Updates from Elvis Sightings
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I got a whole bunch of search engine hits yesterday looking for information about the pending legislation for autism insurance in Wisconsin, due to my post last month about the bill introduced in the Wisconsin Senate (SB3). There was a segment on the show Here and Now on public television last night, and other news coverage I'm sure. Things seem to be happening fairly quickly.

So, here's what I know.

The original author of the bill, Senator Judy Robson, introduced a substitute amendment yesterday (Feb. 6), with some added particulars. In my last post, I mentioned the lack of a dollar cap. That has been addressed in the new version:
The coverage provided must be at least $60,000 for intensive−level services per year per insured, with a minimum of 30 to 35 hours of care per week for a minimum duration of four years, and at least $30,000 for post−intensive−level services per year per insured. Beginning in 2011, the minimum coverage monetary amounts will be adjusted annually to reflect changes in the medical consumer price index.

Another shortcoming of the previous version of the bill was that it did not specifically mention speech-therapy or occupational-therapy services, a common insurance exclusion. The new version does specifically include these.

There is still no age cap mentioned -- this is deliberate. The intent is for insurance coverage across the lifespan. Apparently there were shenanigans in Texas after the law was passed and it went to the insurance commissioner to hammer out the administrative details, at which point an age limit was imposed. Ugly result; I understand, though, that in this state the Autism Society of Wisconsin is on the case.

The expectation for this framing of the autism insurance proposal is that it will result in approximately 1/3 of the kids currently covered by the Medicaid waiver in Wisconsin (the intensive autism therapy program that provides Joy's House Blend) being covered by insurance instead. Very helpful for the wait list!

There is a public Senate Committee hearing on the bill this coming Monday, Feb. 9, at the Capitol in Madison at 10am. JoyDad and I are unfortunately tied up at work, but I hope there's a good showing.

Here's a link to more information about the progress of Senate Bill 3 (the legislative history).

The companion bill, introduced in the Assembly, is Assembly Bill 15.

If you would like to sign up for e-mail updates on these bills (or any Wisconsin legislation), you can do so with the Wisconsin Legislative Notification Service.

You can also check the Wisconsin Autism Insurance Now site, which does a good job with talking points, but perhaps not so good with up-to-the-minute updates. What I've written here is, as of today, much more current than what they've got up.

I think it's time for Wisconsinites to start writing letters / sending e-mails / making phone calls to state representatives...

I should perhaps also mention that there's a Republican response out there as well. This seems to entail throwing just enough money at the Medicaid waiver program in a one-shot pacification maneuver to get people to stop talking about insurance, without any ongoing support for future years or for what happens after the intensive phase is done. Weak.

Last time I posted an outdated link to a map of autism insurance initiatives. Here is one from Autism Speaks that is much more current, and allows one to sign up for e-mail alerts in their own state.

Money is tight, in Wisconsin and everywhere. But I think we've got momentum this time.

Update Feb. 12: It looks like the Senate committee hearing on Monday had good attendance and lots of personal testimony. For the record, here is a link to the streaming video of committee proceedings. The committee voted unanimously the following day to recommend the bill back to the full Senate for passage. Bipartisanship, can you even believe it?! SB3 as amended is now awaiting scheduling for a Senate vote.

Update Feb. 19: See more recent post about the hearing on the Wisconsin Assembly version of the bill, AB15.

6 comments:

Mama Mara said...

I had a scary thought the other day: if autism is covered, could autism become a pre-existing condition that would prevent our kids from getting insurance coverage as adults? Eeek.

JoyMama said...

Mama Mara - But isn't that among the horror stories right now?

The idea is that autism would be a *covered* condition across the lifespan...

It would be good to have a crystal ball to see the unintended consequences, though.

therextras said...

I have a feeling I'm gonna earn my nickname this time. Ahem.

First, I cannot/will not get wrapped into the specifics of WI law being made. (Can't help but mention the analogy to sausage being made. hehe.)

The TX congress is in session now, too, and I can barely track that for what is meaningful to me.

What I want/wanted was a general perspective, and I guess I got it from the last link. From the left sidebar, my understanding is: obtaining legislation that mandates private insurance to cover treatment for autism. Is that an accurate understanding, if simplified?

Would you agree this is an effort on par with covering other chronic illness, other genetic diagnoses (DS?) and resistence to the historical exclusions for treatment of mental illness diagnoses?

Then this quote:
"The insurance legislation supported by Autism Speaks specifically targets coverage of Applied Behavior Analysis (ABA) and other structured behavioral therapies, which are the most effective forms of treatment and have the best outcomes, both in human costs and in long-term economic benefits."

My Lovely JoyFamily, you know what I think of ABA and the mandating of specific techniques. I HOPE your input will steer them towards coverage of services/professionals like OT, ST, and the credentialed baristas (who supervise the uncredentialed baristas).

This is so messy. Will laws like this also include the specific medications that can or must be provided? (Intending you to respond - how illogical!)

I honor your work and commitment to participate in the process. Citizen participation improves the sausage greatly.

I'll be watching and reading ES intently even if I will not be getting the email updates directly from any site in WI.

My word verification is:
pupested.

BRatK

JoyMama said...

Therextras/BRatK - sausage is an utterly applicable analogy. JoyDad brings home stories from his work (as an economist for the state) that make my hair curl.

I think your simplification gets it right. And you bring up an important point about other developmental / genetic / historically-mental-health conditions. Why autism among the many? I think it's two-fold: autism has had the growing diagnosis rate with corresponding high-profile press coverage, and Wisconsin's mechanism for delivering autism treatment (the Medicaid waiver) has fallen behind the need.

I'd love to know how the mental health parity provision in last fall's federal bailout is going to be implemented!

My impression is that Autism Speaks is not a big player in the Wisconsin effort; the Autism Society of Wisconsin is a much higher-profile presence. There are voices at the table who would prefer to say ABA and only ABA, but they have not been the winners so far in how the language is shaping up. For the legislation to have the desired effect on the waiting list, they've pretty much got to be at least as broad as the waiver coverage, which we're of course using for Joy's House Blend program! The current language also specifically INCLUDES speech therapy and OT.

Now I've gotten all specific about the spices in our brand of sausage again! Oops. I really only got quite as specific as I did in the post, with links to legislative updates and latest language and all, due to the Google hits and visits I was getting from within Wisconsin. SOMEBODY needs to be getting the info out there, into a usable package, for those who want the gory details!

Osh said...

I am so very anxious about Monday...a dear friend and advocate is testifying...she is taking my prayers with her.

BRatK said...

And I thought your hair was naturally curly. Go figure.