Florida Insurance Bill and Autism Speaks

[Steve in Florida]

I was speaking with a staffer at my State Senators office today and he told me that Autism Speaks has stepped up and hired a respected lobbyist to support passage of an Autism Insurance Bill in Florida during the next session.

I don't always agree with what AS does, but I've got to giva an "atta boy" to this one.

To Autism Speaks: Well done:)

Steve in Florida

[dickfauth]

great news Steve-Wont help us though as we are erisa. But i am happy for my fellow floridians.

[Steve in Florida]

News story re the upcoming Florida Legislative session and autism / insurance Bill

http://www.sun-sentinel.com/news/local/palmbeach/sfl-flpautism1225pndec26,0,5458192.story

Steve in Florida

[livsparents]

I'm glad to see that political action is on their agenda. From what I know, they look at state by state fights and pick out the ones that will make the most impact (translation: the ones that are most winnable)


Insurance coverage for autism is goal of Palm Beach County commissioner
By Josh Hafenbrack | South Florida Sun-Sentinel
December 26, 2007

Jack Kanjian loves dinosaurs. He's writing a book about his favorites on colored construction paper, illustrated with crayons. When he grows up, Jack wants to run a prehistoric zoo — with real dinosaurs, not just replicas — and start a TV station dedicated to the creatures.

He plays the piano, pee-wee basketball and rides horses competitively. A few weeks ago he went skiing in Aspen.

Jack has autism.

You'd never know it meeting him. He seems like any precocious 9-year-old, an honor student in the third-grade gifted program.

The reason for Jack's success: his parents, Palm Beach County Commissioner Bob Kanjian and his wife, Anne, who had the money to put him through rigorous therapy sessions called applied behavioral analysis during the crucial early years, after Jack was diagnosed with autism at 2 years old.

The treatments ran about $45,000 a year, Kanjian said, and weren't covered by insurance.

Kanjian is using his clout as a county commissioner to advocate that the same coverage be available to everyone with insurance. He wants Florida legislators to mandate that private insurance companies cover autism, a battle that's being waged in a growing number of states across the country.

When his son was diagnosed with the brain disorder, Kanjian recalled meeting a school custodian whose child also had autism. Their incomes determined the level of care each child got, he said.

"The difference between his job and my job shouldn't be the difference between whether his kids make it or not," said Kanjian, a Republican appointed to his commission seat in August by Gov. Charlie Crist. "We're a society that's better than that."

Kanjian added autism insurance to Palm Beach County's legislative priority list, which means the county's legislative staff and $370,000 private lobbying team will push the issue in the spring session.

It's an uphill battle. Insurance companies across the country have opposed such efforts, arguing that as additional coverages are mandated, premiums for all policyholders rise.

But in Tallahassee, the effort has a powerful ally in Senate Democrat Steve Geller of Cooper City. Geller has been trying get autism insurance mandated for years, but he sees more opportunity this spring. It's his final session in a long legislative career.

"I feel really, really strongly about this issue," he said. "I'm going to see if I can persuade some people who might not otherwise vote for it. This is my going-away present."

Geller said he'll likely go for a $10,000 or $12,000 yearly coverage limit for autism treatments — less than what advocates want, but "a lot better than nothing," he said.

Autism is a brain-development disorder that impedes normal social and communication skills. There's a broad spectrum of autism patients. In severe cases or without early treatment, autistic children spend their adult lives institutionalized.

There is no cure, and researchers are unsure what causes autism, although it is believed to be an inherited disorder.

Jack has a moderate case. Like many kids with autism, he didn't respond to his name as a toddler, struggled to communicate and fixated on inanimate objects. He'd stare at ceiling fans and roll his toy trucks back and forth for hours, watching the wheels.

Once his parents got the autism diagnosis, the Kanjians took immediate action. They put him in the exhaustive one-on-one therapy sessions, running about 40 hours a week. He started achieving real breakthroughs when his 7-year-old sister, Hannah, started to talk. Suddenly, he had a model for how to communicate and to interact.

Jack's made such progress, his parents don't even tell his sports team coaches that he has autism.

But such treatments are out of reach even for most upper-middle class families. Many take out second mortgages to pay for the treatments and end up in debt and divorce, according to autism advocates.

Seventeen states mandate some level of autism coverage, although New York-based Autism Speaks, an advocacy organization, says only four states offer adequate benefits. South Carolina has the most comprehensive plan with a yearly coverage limit of $50,000 for autism treatment, said Elizabeth Emken, the group's vice president of government relations.

"It's an issue that's time has come, frankly," she said. "Nobody's really debating that these kids need this. The argument is who should pay for it?"

Kanjian, a former Palm Beach county School Board member, said he views autism insurance as a good business decision. Kids with autism in special-needs schools cost the school district about $23,000 a year, triple an average student. And having autism patients institutionalized as adults can cost the state millions later in life, he said.

"You're going to save their lives," he said. "But second, what a great investment."

Anne Kanjian, watching her son flip through his dinosaur book, added: "He's going to grow up and go to college and maybe find the cure for autism."

Staff Writer Josh Hafenbrack can be reached at jhafenbrack@sun-sentinel.com or 561-228-5508.

[Steve in Florida]

Donald Trump gets involved in fundraising:

http://www.sun-sentinel.com/news/local/palmbeach/sfl-flpautism1228pndec28,0,7162133.story

Steve in Florida

[t-bean]

I'm glad to see that political action is on their agenda. From what I know, they look at state by state fights and pick out the ones that will make the most impact (translation: the ones that are most winnable)

Yes, this is correct. Florida, Michigan and California (and PA from last year) were chosen as they have effective grassroots volunteers willing to go start making headway with legislators to pass the insurance iniatitives in those states. They are also battleground states for the 2008 Presidential election which will make political activity in those states more visable to the rest of the country.

The long term goal of passing in individual states is to eventually have enough coverage in many states to warrant the passage of a federal bill that would require universal coverage of autism treatments for all Americans with autism.

[Steve in Florida]

It's time that Florida mandated insurance coverage for autism treatments
South Florida Sun-Sentinel Editorial Board
January 6, 2008

ISSUE: Effort is on to require insurance companies to cover autism treatments.

Even with medical advances, autism is so relatively new as a diagnosed disease that frighteningly little is known about it, particularly why it develops and how it can be prevented or cured.

But one key fact is known about this debilitating brain-development disorder afflicting one in 150 children: Early intervention is key. Experts say aggressive treatments give autistic kids aged 3 and younger a 50 percent shot at matriculating through mainstream public school with limited assistance.

Sadly, the stumbling block for many parents is money. Treatments can run about $50,000 a year or more, and private insurance doesn't cover them. Yet.

An aggressive effort is under way to get Florida to pass legislation requiring limited coverage for autism treatments. It's not a new idea. Seventeen states require some level of coverage for autism, though New York-based Autism Speaks only rates mandates passed by four of the states as adequate.

It's high time Florida get on the bandwagon. State Sen. Steve Geller, D-Cooper City, has tried for years to get legislation on the books mandating autism coverage, but the effort hasn't made it to the floor for a full vote. This session, Geller's last, he hopes will be different.

So does Autism Speaks, which is mounting a major lobbying push, and the Palm Beach County Commission, which put autism coverage on its legislative priority list at the behest of Commissioner Bob Kanjian, whose 12-year-old autistic son is thriving after intensive early-intervention efforts.

Hoping to strike a balance, Geller says he'll likely back a yearly coverage limit of $10,000 or $12,000, less than what advocates are seeking but far better than the status quo.

The insurance industry, of course, is opposing such efforts, arguing that mandatory coverages will drive up premiums for all policyholders. But coverage is needed, and it won't come without a mandate. The thousands of autistic children struggling with the disease deserve a fighting chance at normalcy, and that chance shouldn't be reserved only for the wealthy among them.

BOTTOM LINE: Pass the coverage mandate.

[ellen_cicconi]

Great editorial. I hope it has the desired effect on Floridians and their lawmakers. Don't forget, there is a pdf doc with arguments to provide in favor of the legislation when you contact your reps and sens.

Arguments in Support of Private Insurance Coverage of Autism-Related Services. (http://www.autismspeaks.org/docs/arguments_for_private_insurance_coverage.pdf)

[boggeymann]

thank god at least Crist is doing something for our beloved state. At least i know i voted for the right man.

[Steve in Florida]

thank god at least Crist is doing something for our beloved state. At least i know i voted for the right man.

I voted for Charlie too, but he has nothing to do with this effort, or at least he hasn't weighed in yet.

This Bill will be sponsored by the Democratic Leader in the Senate, Steve Geller. Both Chambers of the Fl Legislature are dominated by the Republicans, as is the Governors office.

I am hopeful that this will not become a partisan issue in the session that starts in March.

Steve in Florida

[Steve in Florida]

Today is the third day of the Florida Legislative session and the Autism / Insurance Bill has been filed. The House companion has several co-sponsors with some bi-partisan support.

http://www.flsenate.gov/Session/index.cfm?Mode=Bills&SubMenu=1&BI_Mode=ViewBillInfo&Year=2008&BillNum=2654

Steve in Florida

[jennim-b]

One thing that those of you in Florida should to is contact your reps in the House and Senate and ask them to support the bill.

You can find out your rep by going here http://www.leg.state.fl.us/Welcome/index.cfm?CFID=33952576&CFTOKEN=89913276

[akmomof2]

I am going to start working with legislators to have an Autism bill in Alaska. This is a great thread for me to research and help me get the ball rolling.

Any extra info...please feel free to pm me!

[Steve in Florida]

This morning the Florida autism / insurance bill passed the first Committee in both the Senate and the House of Representatives.

Before the Bills can "go to the floor" in each chamber for debate and vote they will each have to pass at least one "appropriations" Committee.

Good first step

Steve in Florida

[Dadvocate]

I am going to start working with legislators to have an Autism bill in Alaska. This is a great thread for me to research and help me get the ball rolling.

Any extra info...please feel free to pm me!


You should call or email Elizabeth Emken at Autism Speaks. They have a wealth of info they may be able to provide to help in your efforts. My state, Illinois, was not chosen as an initial battleground but we are forging ahead with SB 1900, an insurance coverage bil that just cleared committee. A rally is being held in Springfield, IL on April 15 to support it and other autism legislation so all you Illini out there, please save the date and come to the rally!

Insurance coverage won't help me at this point. We did a decade of ABA, etc. It was a very effective therapy for my son. He has impaired communication skills but does have functional expressive language, and pretty good receptive (but alas is unable to read). I shudder to think what the level of those skills would be if we hadn't been able to afford to do ABA out of pocket (big $ ouch). I don't want to see other families feel that pain.

[Steve in Florida]

Florida legislators urged to act on insurance coverage for autistic children
Legislators hear plea for insurance aid
By Linda Kleindienst | Tallahassee Bureau Chief
March 19, 2008
Article tools
E-mail Share
Digg Del.icio.us Facebook Fark Google Newsvine Reddit Yahoo Print Reprints Post comment Text size: TALLAHASSEE - Daniel Barta knows his name and age. For most 4-year-olds, that's no big deal.

But for the Pembroke Pines boy, who was diagnosed with autism last year, it has taken months of intensive behavioral and speech therapy to get this far.

His progress has come at a cost of $4,000 a month. Not a dime for the treatment has been paid by an insurance company. Instead, his family has taken out a home equity loan.




Daniel's father Bart on Tuesday joined dozens of other parents — and their children — in asking Florida's Legislature to force health insurance companies to broaden their coverage to include autistic children.

The families' message was the same: at present, only those fortunate few who can afford to pay themselves for the individualized and highly regimented treatments can give their sons and daughters they help they need.

"I'm a police officer. I had to get a line of credit on my house and I'll sell my house if I have to," Bart Barta, a 42-year-old father of three, told the House Committee on Health Innovation, his voice crackling with emotion. "I pay $6,000 a year in health insurance premiums, but this is not covered. That's morally wrong."

An estimated 1 in 150 children in the United States is afflicted with autism, a developmental disability that affects the functioning of the brain and hinders the ability to communicate and interact with others. For boys, it's 1 in 94. And studies show the numbers are growing.

According to a 2006 Harvard study, it can cost $3.2 million to care for an autistic person over a lifetime.

"Early interventions are the key to success later in life," said Rep. Ari Porth, D-Coral Springs, the House sponsor of a bill requiring insurance companies to cover treatment costs. "Many children have become verbal and mainstreamed into school."

Jack Kanjian, the son of Palm Beach County Commissioner Bob Kanjian, is one of those success stories. His family was able to pay for his therapy.

As a toddler, Jack didn't respond to his name, stared at the ceiling fan and focused on the wheels of his toy trucks as he rolled them back and forth for hours.

On Tuesday, the confident 9-year-old told legislators that he is now "just a regular kid" in a gifted third grade class who plays baseball and soccer, rides horses and recently scored at the top of his class on an FCAT math practice test.

"I was lucky because my parents gave me the chance to beat autism," he said.

Bob Kanjian, who was appointed by Gov. Charlie Crist to serve on a state autism task force, said all children deserve care as good as what Jack had.

"He's done well because we had the financial means to get him where he needs to be," Kanjian said.

Only four states — Indiana, Minnesota, South Carolina and Texas — require insurers to cover autism therapy under their general health insurance policies. Insurance companies are generally hostile to the idea, which they say will boost everyone's premiums.

Susan Pisano, a spokeswoman for the Washington-based America's Health Insurance Plans, which represents companies that provide insurance to more than 200 million Americans, said her organization opposes all state-ordered mandates on what must be covered.

"Across the country, there are 3,000 mandates on the books and the cumulative effect has made it difficult for many employers to offer health care for their employees," she said.

The legislation filed by Porth and Senate Democratic Leader Steve Geller, of Cooper City, requires insurance companies to cover up to $36,000 of the cost of autism treatment annually until a child turns 18 or finishes high school.

On Tuesday, the measure passed the House committee by a 4-3 vote and was approved unanimously by the Senate Banking and Insurance Committee. Crist has said he is open to considering the legislation if it reaches his desk.

Linda Kleindienst can be reached at lkleindienst@sun-sentinel.com

[Steve in Florida]

The second meeting of this Committee was held yesterday afternoon through to 8PM. The first was at the beginning of the week and the speakers were the heads of State departments that deal with disabled issues like Education and the Agency for Persons with Disabilities.

Last night there were approx 40 speakers, all but a couple parents with their stories. The Committee members were paying much more attention than they usually do at these type meetings. At least 3 members have disabled children of their own.

Autism Speaks Lobbyist spoke and was one of only 2 non parents to testify.

The testimony by these parents was very moving and some excellent points were made. I will try and aquire the video and post a link to it when I can

Steve in Florida


The Speaker of the Dflorida Houses announcement:

http://www.myfloridahouse.gov/Sections/Documents/loaddoc.aspx?DocumentType=Press Release&FileName=103

Marco Rubio
Speaker
420 Capitol Building
(850) 488-1450
402 South Monroe Street, Tallahassee, Florida 32399-1300
FOR IMMEDIATE RELEASE April 4, 2008 Contact: Jill Chamberlin 850-921-2002
Jill.Chamberlin@myfloridahouse.gov RUBIO NAMES 13-MEMBER SELECT COMMITTEE ON AUTISM TALLAHASSEE—House Speaker Marco Rubio today announced the appointment of 13-members to a newly created House Select Committee on Autism and Developmental Disorders. Rubio named State Rep. Andy Gardiner, R-Orlando, to chair the committee. Rubio said the Committee should submit its initial recommendations within one week of its April 8th first meeting. A copy of Rubio’s appointment letter is pasted below. Other members of the House who were named by Rubio to the Select Committee are: Reps. Bill Galvano, vice chair, Loranne Ausley, Ari Porth, Jimmy Patronis, Will Weatherford, Dennis Ross, Audrey Gibson, Joseph Gibbons, Anitere Flores, Juan Zapata, Marti Coley, Stephen Precourt. April 4, 2008 The Honorable Andy Gardiner Florida House of Representatives 303 House Office Building 402 South Monroe Street Tallahassee, Florida 32399-1300 Dear Representative Gardiner:
This session, despite an array of legislative priorities that require our time and attention, the issues of treatments for autism and other developmental disabilities have surged to the forefront as a legislative priority. After consultation with Healthcare Council Chair Rep. Aaron Bean, it is apparent that any solution requires a multi-disciplinary approach that incorporates expertise from the healthcare, education
2
and insurance fields. Accordingly, I am creating a Select Committee on Autism and Developmental Disorders to look at these issues. Pursuant to Rule 7.6, you are hereby appointed to serve as a member of the Select Committee on Autism and Developmental Disorders. At the recommendation of Health Care Council Chair Aaron Bean, I am also naming you to chair this select committee.
The purview of the committee will be to consider ways to best utilize public and private resources to assist families in Florida with children coping with autism spectrum disorders or other developmental disabilities. Early detection and treatment are critical to the well-being of these young people. Not only will children with these developmental disorders benefit from these services, but all of Florida will benefit from their successful education and integration into society.
While mandatory insurance coverage has been suggested as one solution, it is important to note that more than 50 percent of the health insurance sold in Florida is not subject to state mandates. A costly mandate could jeopardize the ability of many to maintain their insurance. Policies that are subject to such mandates cover fewer than three million citizens. Many more children need and deserve our help.
Florida in the past decade has deliberately moved toward an educational system that offers flexibility and choice, both in early childhood education through the VPK program, and as children grow, through our public education system and the McKay scholarship program. Our challenge and your charge is to examine how to best meet the needs of children with autism spectrum disorders and other developmental disabilities that involve behavioral health disciplines and educational programs, and how these programs might best be funded.
A final report of the committee findings and recommendations shall be submitted no later than April 15, 2008. It is my intent that legislation would be taken up in Chairman Bean’s Health Care Council as soon as possible. I realize this is a tight timeline, but you have my full confidence that a sound work product can be produced promptly.
Thank you for your service to the Florida House of Representatives and the people of Florida
Sincerely,
Marco Rubio
Speaker

[jennim-b]

http://www.myfloridahouse.gov/Sections/Committees/committeesdetail.aspx?SessionId=57&CommitteeId=2441

Look under video archives for videos of both meetings.

[Steve in Florida]

http://www.myfloridahouse.gov/Sections/Committees/committeesdetail.aspx?SessionId=57&CommitteeId=2441

Look under video archives for videos of both meetings.

Thanks Jennim,

I was hoping they would post that. What did youn think?

Steve in Florida

[boggeymann]

anyone have any info on what happened today they where supposed to submit there recommendation today

[Steve in Florida]

anyone have any info on what happened today they where supposed to submit there recommendation today

They heard testimony from a variety of different agencies including insurance regulation. It's posted on the site Jen reffered to a couple posts back if you want to watch.

Friday they are supposed to have their final meeting and present a plan. I have heard that this Committee will not vote on a Committee Bill but that the Health Council and Ed Council are drafting Committee Bills for those two Councils that will incorporate the Select Committee recommendations.

I have heard that the Healthcare Council is working on something that will consolidate a variety of services into something comprehensive and try and pull down some Fed dollars to fund. Kid Care, CARD, Med waiver, Fiddlers, etc all coordinated to provide 1 to 4 year old services.

I have been trying but have not heard anything about what they plan to do about ED. Both Chambers budget's cut Ed spending pretty bad on top of some pretty bad cuts last year. It's going to be hard to find dollars to do anything about Ed and the FDOE are hard nosed bunch that don't budge easily.

From listening to the testimony and seeing the reactions of the members I also think they will do something about Dr's hemming and hawing about diagnosis. They heard many a story about delayed diagnosis because of Dr reluctance to refer or dx.

I have watched this issue come to the House for almost 10 years and have been an active part of lobbying for it for a couple of those years. House Leadership is extremely reluctant to support any insurance mandate. Watch the beginning of the first meeting and listen to Speaker Rubio talk about insurance mandates.

The Bill is sponsored by a Democrat in a very predominantly Rebublican House. The insurance lobby is extremely powerful and has not had any Representative speak before the Committee. They know they don't have to defend their position, and if they did it would be very bad for their public relations, so far they have sat out.

It's not over yet and the next 3 weeks will tell the tale.

Friday should be interesting

Steve in Florida

[Steve in Florida]

I "stumbled" upon this from an Insurance Industry source in Florida. As I understand it was sent to Insurnace company personel Statewide:

Steve in Florida

____________________________________


SELECT COMMITTEE ON AUTISM COMMENCES MEETINGS

The newly-formed Select Committee on Autism held its first meetings this week to begin discussions on increasing awareness and coming up with public and private solutions to assist families with autistic and developmentally disabled children. During the first meeting, the committee received testimony from experts and agency representatives, public testimony was taken at the second meeting, and the third and final meeting will be held next week to discuss proposals.

The House and Senate bills (HB 1291/SB 2654) mandate coverage for autism spectrum disorder by specified health insurance plans and provide eligibility requirements for coverage. The Senate bill advanced through another committee this week and is now lined up to go to the Senate floor. The House bill is awaiting a hearing in its second committee, which appears unlikely as committee meetings will be wrapping up as early as next week. However, this mandate has the best chance of passage of any mandate to be addressed in Tallahassee in a decade. Please contact your legislators to oppose SB 2654 and HB 1291!

[BrendaLee]

Steve,

Do you know who (or which group) sent the message?

[Steve in Florida]

As of last evening there were a mind numbing 71 co-sponsors for the Florida House of Representatives autism / insurance bill (H1291) sponsored by Representative Ari Porth.

While co-sponsorship in and of itself means nothing as far as votes, it is a serious show of support for the Bill.

I think the House Leadership will have something to show the insurance industry with this, and how it will be very difficult to not move this Bill in the face of overwhelming bi-partisan support.

This is all due to the grass roots determination of parents and other interested parties lobbying House members to support this effort.

Go Florida

Steve in Florida

[Steve in Florida]

A very suprising turn of events this morning. I was standing by to tap the webcast of the FL House Select Committee on Autism's last meeting this morning, the standby for feed was there with an 8am start time, and at around 8am I refreshed the page and the meeting was gone.

The session starts at 10am so maybe the Speaker will make some type of announcement and I'm trying to find out whats up.

I had heard that the Committee was going to hear a Proposed Committee Bill PCB and then were going to send it to the Healthcare Council for that Council to sponsor and debate, supposedly Monday.

This may have something to do with the fact that the Austim Insurance Bill now has approx 80 co-sponsors.

Steve in Florida

[JohnnysMom88]

Thanks for the update Steve, please keep us posted. I got my fingers crossed over here..

[boggeymann]

thanks steve let me know also plz since I am also in Florida and would love to hae this bill passed crossing my fingers

[Steve in Florida]

It seems that Leadership wants to take a longer look at what came out of the select Committee on Autism.

It is worth noting that although the House Insurance Bill has about 80 co-sponsors now none of them are in Leadership.

From what I understand staff from the Education Council and the Healthcare Council collaborated on the product that will be heard. I believe the plan now is to have a Proposed Committee Bill heard in the Healthcare Council maybe as soon as Monday. It will be something comprehensive that will include education, early intervention, kid care, CARD, healthcare and other components.

It unclear at this time what will become of the Insurance part of the Bill. It may be included or it may be addressed seperately. I do not rule out that leadership may let it die, it is still a possibility even with a high number of bi-partisan co-sponsors.

All Council and Committee meetings are now on short notice and could be called with as little as 2 hours notice. More than likely before the end of the week the House (and Senate) will stop having Committee meetings and only hear Bills in session that have already passed out of Committee.

More monday, have a great weekend :D

Steve in Florida

[Steve in Florida]

The Select Committee on Autism and Developmental Disabilities met this evening for a brief one hour show and tell.

The Bill they presented is pretty comprehensive, some compromise in the insurance part, but expanded Kidcare and CARD stuff along with some ED things, especially changes to the McKay Scholarship which is my pet project.

Tomorrow the Proposed Committee Bill will be heard in the Healthcare Council where there will probably be a few amendments and then on to the Floor.

Over the weekend the Chairman of the Committee, Rep Gardiner met with Senator Geller, the Senator that is sponsoring the insurance Bill in the Senate. The Committeee indicated that Senator Geller was Ok with what they were proposing which should help in the Senate.

This will probably go right to the wire, session ends in 2 weeks.

Steve in Florida

[Steve in Florida]

Senator Geller's "Window of opportunity" or autism /insurance bill passed the Senate a few minutes ago 39 to 0.

1 chamber down, 1 to go and then to the Governor

Steve in Florida

[Dadvocate]

Senator Geller's "Window of opportunity" or autism /insurance bill passed the Senate a few minutes ago 39 to 0.

1 chamber down, 1 to go and then to the Governor

Steve in Florida

Congratulations

[boggeymann]

steve what is the Deal with Rubio and his bill that was supported by Blue cross blue shield it was in the Miami Herald today and about this 108,000.00 life time limit per person? BTW what is kidcare

[JohnnysMom88]

Florida kidcare is low cost health insurance, for people who do not qualify for medicaid, but still need low cost insurance.

[Steve in Florida]

Saturday April 26

The Senate Bill S2654 has passed the Senate and gone to the House in messages. This is the insurance mandate Bill that Senator Geller has been sponsoring for the last 10 years.

The House, as I understand the process, wiil by rule hear the Bill.

The House has passed out of the Healthcare Council PCB HCC 08-27 which has a different insurance component than the Senate's outright mandate and also includes several other components including streamlining early care, kidcare, the CARD centers, the McKay Scholarship etc.

The insurance component in the House Bill is a kind of phase in of a mandate where the insurance companies will have 2 years to provide coverage for autism therapies and if they don't in that period it will becoma a mandate.

My personal opinion is this is a stall to give the insurance companies 2 years to weasel out of the mandate, their lobby is VERY stong, especially in the House.

There will be much debate over the weekend between the Senate and the House over how to compromise the two Bills. Senator Geller was consulted about the final draft of the House Bill and I believe some of the House Bill components will be safe, especially the ones with little or no cost.

The big debate will be where to draw the line on the insurance mandate.

All parties seem to agree that both these Bills have too much momentum for them to die before the end of session. There has been too much time invested and too much press coverage for this issue to stall. House Speaker Rubio has made this issue a priority late in the session (he created the Select Committee on Autism April 2) and has personally spoken at 2 meetings. This indicates a strong will to send something to the Governor.

The Senate passes Senator Gellers Bill 39-0. This also indicates a willingness to see a Bill become Law.

As I understand it the main negotiators from the Senate will be the Majority Leader Senator Webster and Senator Geller (Minority Leader.) The House will probably send Representative Gardiner, the Chair of the Select Committee on Autism and Developmental Disabilities and Representative Porth the sponsor of the identical Bill to Senator Geller's insurance mandate Bill.

The session is scheduled to end this Friday, and it is expected that something will come out of joint conference perhaps early in the week.

This is a great source for news coverage of the issue:

http://www.ffddnews.com/

You can also watch debate and testimony in the Select Committee on autism here:

http://www.myfloridahouse.gov/Sections/Committees/committeesdetail.aspx?SessionId=57&CommitteeId=2441

And the last meeting of the Healthcare Council that passed the Bill here:

http://www.myfloridahouse.gov/Sections/Committees/committeesdetail.aspx?SessionId=57&CommitteeId=2348

You will need to go to the bottom of the pages and click the dates to watch the video coverage. In Healthcare only the April 22 meeting is relevant.

As with all sessions, this has been a roller coaster, only 5 days left.



Steve in Florida :)

[t-bean]

Autism by the numbers for family urging lawmakers to act

Published Saturday, April 26, 2008 at 4:30 a.m.

PORT CHARLOTTE, Fla. — Sharon Boyd crunches the numbers when she urges the state to require insurance companies to cover autism:

- 8: the age of her autistic son, Austin.

- One in 150: the frequency with which a child is diagnosed with autism.

- $500-$600: the monthly premiums she paid for a health insurance policy that excluded autism.

- 25-40: hours of intensive behavioral therapy a week recommended to treat autism.

- Three : hours of behavioral therapy Medicaid will cover for Austin each week.

- $50,000: what some families pay out-of-pocket for behavioral therapy.

- $0: what the Boyds can afford to pay for that therapy.

Florida legislators have tried to require insurance companies to cover autism for almost a decade, but concerns about raising health insurance premiums for businesses and families have stalled them. Senate Democratic Leader Steve Geller of Cooper City has made one such proposal his priority this session, his last because of term limits, but it faces opposition from the powerful insurance industry that contends any health coverage mandate raises costs by as much as 30 percent.

Boyd argues that not having insurance coverage for her autistic son costs her family and taxpayers far more. She quit her job as an oncology nurse and dropped her insurance policy to get Medicaid for Austin and state health care for her other four children.

"I want people to understand that I'm not a person that said 'gimme, gimme, gimme.' I tried to take care of it myself," says Boyd, 41. "I am only living on the government dollar because I was forced to, because they will not step up and mandate insurance coverage."

Boyd is among the parents who've been pushing Florida lawmakers to join a dozen other states in requiring insurance companies to cover screening and treatments for autism and related disorders.

Many health insurance plans do not cover autism spectrum disorders, leaving families like the Boyds to either seek services through state or federal programs or pay the costs themselves.

The state Senate on Wednesday unanimously passed a bill (SB 1291) mandating autism coverage by large health insurance plans, including $36,000 a year for behavioral therapy. A substantially different approach cleared an important committee in the House this week. That measure (HCC 27) would give insurance companies until 2010 to work out an agreement with state regulators for autism coverage. Meanwhile, some services would be available through the state's pre-kindergarten and subsidized KidCare health insurance programs.

Advocates such as Boyd, who leads advocacy in Florida for New York-based Autism Speaks, want the Senate's measure to become law and have urged the House to vote on it before the end of the session Friday. Meanwhile, the Florida Insurance Council has said it prefers the House measure and sharing coverage with state and federal service providers.

Insurers and advocates also disagree over the cost of an autism mandate. Insurance companies say premiums will go up but haven't provided statistics showing how much.

But Boyd's group, Autism Speaks, estimates the coverage would only increase costs by less than $2 for individual policies and less than $5 for family policies. At the same time, with insurance coverage, autistic children would be less dependent on schools and government programs, the group says.

Boyd and other parents say that's a small price to pay, especially compared to the money they've already laid out for their children's care. The Port Charlotte mother of five doesn't want her sandy-haired, husky son, with his giggles and injurious fits, to be thought of in dollar figures, but such numbers have defined his care.

Her husband's $20,000 salary as the sole employee of his pest control business doesn't allow them to pay independently for recommended therapies. Boyd quit her $38,000-a-year job when Austin was 4 so her children would be eligible for subsidized health care.

Austin spent four years on a waiting list for a limited $14,792 Medicaid waiver that allows him to get three hours of behavioral therapy a week. Doctors recommend 25 to 40 hours a week.

"As severe as he is, it's not going to help him that much, but it's all I can get and it's better than zero," Boyd says.

Austin got the waiver in 2006, but Boyd only recently found a local provider that will accept it. Austin has had only a handful of behavioral therapy sessions, paid for by the state, since his diagnosis at age 2 1/2.

He's still on a waiting list for a more comprehensive Medicaid waiver, along with 16,000 other Florida children and adults with developmental disabilities.

He also receives $570 a month in federal subsidies. Boyd says that money pays for batteries for Austin's train sets - his obsession. It will also help pay for converting their garage into a bedroom for Austin, who for now sleeps locked in his parents room to keep him from hitting his younger brother during the night. The money also pays for repairing things he destroys in the family's modestly furnished home during violent episodes that his family believes could be alleviated with enough behavioral therapy.

Boyd fears that time is almost up for Austin to benefit from that therapy, which experts say is most effective when begun in early childhood. For now, the numbers in her head keep multiplying.

"We're not able to save any money, so who's going to support his very expensive needs when he's an adult?" Boyd says.

[passionlessDrone]

Hello friends -

This bill has been gutting by ammendments by a legislator who has been against the bill from the start. Nice touch. Timelines have been pushed back to 2009, there is a fixed number of children who can enroll, etc.

Oh well.

-pD

[Steve in Florida]

all the latest news stories can be foung here:

http://www.ffddnews.com/


pd, are you in Florida? it ain't over until Friday

Steve in Florida

[Richard in Florida]

Steve, you are right. As the wise man said, “It’s not over until it’s over.” I hope we can all make something happen this session. Just like learning to walk, we may have to take baby steps first.

I hope you don’t mind, I followed your link and included below some details for those who may not have time to click all the links and read all the articles. Last week, I also prepared a detailed summary, which I will post separately (due to length limits). Regardless of the outcome, some may want to dig into the details of what has happened this session. I welcome your thoughts, input and corrections.

Richard in Florida
Father of twins born prematurely in 2004 after only 25 weeks; our son was diagnosed with ASD.


Update (April 29, 2008 11:00 AM)

The articles below reflect the general perception that, because the House and Senate are now each pushing very different bills, the end result is likely to be no bill at all. The Senate bill has not budget impact, while the price tag for the House bill is estimated to be over $100 million. In a year of severe budget cuts, it appears unlikely at this point in the session that a bill that impacts the budget will pass in the House or Senate, regardless of the good intentions behind the bill and strong support for the perceived benefits.

Autism Speaks has stated elsewhere that it believes that it is important that as many citizens as possible send a strong message of support to members of the Senate and House in favor of the Senate version of the bill. Autism Votes is urging Florida residents to Take Action in Florida: Call and Email House Speaker Marco Rubio and Urge Him to Bring up SB 2654 for an Immediate Vote in the House Without Amendment!! (http://www.autismvotes.org/c.frKNI3PCImE/b.4054265/siteapps/advocacy/ActionItem.aspx)

Articles:
Tallahassee Democrat: Autism bill may need trimming to pass (http://floridacapitalnews.com/apps/pbcs.dll/article?AID=/20080429/CAPITOLNEWS/804290326):

House members are determined to have that bill preserved, even with its estimated price tag of upwards of $100 million and no money in the budget, said Sen. Steve Geller, D-Cooper City, and the sponsor of the Senate bill.
"I'm no longer hopeful for any bill passing," Geller said. "They want everything included. They're loving it to death," meaning it's loaded with so many good-sounding things that it becomes impractical, or too expensive, to gain approval.
"I'd love to do something for all disabled children, but the costs make it prohibitive," Geller said.

Palm Beach Post:
· Articles:
o Politics of autism (http://www.palmbeachpost.com/blogs/content/shared-blogs/palmbeach/floridapolitics/entries/2008/04/28/politics_of_autism.html):

State House leaders acknowledged Monday that the state doesn’t have the money to have Medicaid and Healthy Kids cover all Florida children with autism. But they still oppose the Senate plan that would immediately require private health insurers to cover autism treatment.
Instead, the House wants to “put a mechanism in place” to have autistic kids get coverage through Healthy Kids whenever the money becomes available.

o Insurers must cover autism, says Crist (http://www.palmbeachpost.com/business/content/business/epaper/2008/04/28/or24mandate.html)

· Editorial: Require autism coverage (http://www.palmbeachpost.com/opinion/content/opinion/epaper/2008/04/29/m14a_autism_edit_0429.html)

The goal of House Bill 1291 and Senate Bill 2654 is the same: to provide health insurance coverage for children with autism. But neither bill would fully accomplish what is in the best interest of the estimated 10,000 autistic children in Florida and what is in the state's financial interest. A compromise that accomplishes both, however, still can happen during the last week of this year's legislative session.

The News-Press: Crist favors Florida Senate version of autism insurance bill (http://www.news-press.com/apps/pbcs.dll/article?AID=/20080428/NEWS0120/80428027/1075) –

Crist said he favors the Senate's approach, in a bill by Sen. Steve Geller, D-Cooper City. The Senate bill mandates that large insurance companies, which would cover about 55 percent of all people insured in Florida — provide coverage for autism diagnoses and treatment. Insurance companies have said they can do that for rate increases of no more than a half-percent on all policyholders.
Geller himself has praised the House plan for its efforts, but said the price tag could make it impractical. It also sets up a scenario of having poor children competing with disabled children for a limited number of coverage slots in Healthy Kids.

Herald Tribune: Crist wants to pass gas tax, autism mandate (http://www.heraldtribune.com/article/20080428/BLOG29/203821444/-1/RSS1010)
news-press.com: Crist favors Florida Senate version of autism insurance bill (http://www.news-press.com/apps/pbcs.dll/article?AID=/20080428/NEWS0120/80428027/1075)
sun-sentinel.com (The Associated Press): Bills would increase insurance aid for autism therapy (http://www.sun-sentinel.com/news/local/florida/sfl-flfautismsbapr28,0,4423592.story)

[Richard in Florida]

Many people want to know more about what is going on in the Florida legislature regarding treatment of children diagnosed with autism spectrum disorders. It is hard to keep up and the information is not easy to find.

I am posting some details (in four parts due to posting length limitations). I have included a number of links so that you can learn as much as you want. There is a lot to digest, particularly the complexities of the expanded House bill. Regardless of the outcome, you may want to dig into the details of what has happened this session.

Part 1: Summary of Autism Spectrum Disorder Bills in the Florida Legislature (last updated April 25, 2008 2:00 PM)

Summary

Many people want to know more about what is going on in the Florida legislature regarding treatment of children diagnosed with autism spectrum disorders. It is hard to keep up and the information is not easy to find. I have included a number of links below so that you can learn as much as you want. There is a lot to digest, particularly the complexities of the expanded House bill. Regardless of the outcome, you may want to dig into the details of what has happened this session.

The Senate passed its bill. The House bill has not yet made it to the floor of the House and time is running out for action in 2008. FYI:

The Florida regular legislative session is 60 calendar days long; today is day 53. After the regular session, special session would have to be called specifically to address this legislation.
During the session, the House and Senate much each pass their bills and then negotiate and agree on compromise legislation.
For those who do not know and want some insight into the complexities of the process, the Florida House has posted: How A Bill Becomes Law (Explanation) (http://www.myfloridahouse.gov/contentViewer.aspx?Category=PublicGuide&File=About_The_Legislative_Process_How_A_Bill_Beco mes_Law_Explanation.html) and How a Bill Becomes a Law (Chart) (http://www.myfloridahouse.gov/contentViewer.aspx?Category=PublicGuide&File=About_The_Legislative_Process_How_A_Bill_Beco mes_Law.html))
Just for fun, you may have seen this: Schoolhouse Rock- How a Bill Becomes a Law (http://www.youtube.com/watch?v=mEJL2Uuv-oQ&feature=related)The original House bill (http://www.myfloridahouse.gov/Sections/Documents/loaddoc.aspx?FileName=_h1291__.xml&DocumentType=Bill&BillNumber=1291&Session=2008) was very similar to bill passed by the Senate (http://www.flsenate.gov/data/session/2008/Senate/bills/billtext/pdf/s2654e1.pdf). On April 4th, Speaker Rubio encouraged a broader approach and appointed a Select Committee to study alternatives. The Special Committee approved a substitute bill which it forwarded to the Healthcare Council. The Healthcare Council approved the substitute bill at its meeting on this week (April 22nd). During that meeting, Speaker Rubio told the Healthcare Council not to worry about having the time to address the recommended changes (see summary below and this article (http://www.tbo.com/news/metro/MGBQ9PQDDFF.html)) or having the funds necessary to implement those changes. The Healthcare Council has not yet forwarded the bill to the full House. The Healthcare Council indicated that discussions would be ongoing through the week and weekend before submission to the House next week. It was suggested during the meeting that negotiations were ongoing with the Senate.

If the House and Senate agree on one bill, they must submit the legislation to the Governor for his signature. Governor Crist has spoken favorably about such insurance mandates (click here (http://autism2008.wordpress.com/2008/04/18/florida-gov-stands-up-for-autism-community/)) and about the Senate legislation (click here (http://www.orlandosentinel.com/news/local/state/orl-flautism0308apr03,0,6847025.story) and click here (http://www.heraldtribune.com/article/20080424/NEWS/804240557/-1/RSS01)), but perhaps not the House legislation promoted by Speaker Rubio (click here (http://miamiherald.typepad.com/nakedpolitics/2008/04/three-things-cr.html)). Governor Crist formed the Autism Task Force (click here (http://www.flgov.com/release/9900)) to address some of the new issues addressed by the substitute House bill. The Governor and Chief Financial Officer Sink disagree about the House bill (click here (http://www.palmbeachpost.com/blogs/content/shared-blogs/palmbeach/floridapolitics/entries/2008/04/22/crist_sink_take_different_cour.html#commentsform)) . FYI, CFO Sink oversees the Department of Financial Services and its 13 divisions, including the Office of Insurance Regulation.

Interestingly, representatives from the Florida Insurance Council and Blue Cross Blue Shield of Florida told sponsors they support the plan (http://www.miamiherald.com/top_stories/story/506023.html) approved by the Special Committee and Healthcare Council, while insurance companies generally oppose the Senate bill and insurance mandates generally (click here (http://blogs.tampabay.com/buzz/2008/04/insurers-attack.html) and click here (http://www.fahp.net/images/one%20pager.pdf))


Richard in Florida
Father of twins born prematurely in 2004 after only 25 weeks; our son was diagnosed with ASD.

[Richard in Florida]

Many people want to know more about what is going on in the Florida legislature regarding treatment of children diagnosed with autism spectrum disorders. It is hard to keep up and the information is not easy to find.

I am posting some details (in four parts due to posting length limitations). I have included a number of links so that you can learn as much as you want. There is a lot to digest, particularly the complexities of the expanded House bill. Regardless of the outcome, you may want to dig into the details of what has happened this session.

Part 2: Summary of Autism Spectrum Disorder Bills in the Florida Legislature (last updated April 25, 2008 2:00 PM)


The latest:

Florida Senate:
· SB 2654 – Relating to Autism Spectrum Disorder
o General Information: click here: bill summary (http://www.flsenate.gov/session/index.cfm?Mode=Bills&SubMenu=1&BI_Mode=ViewBillInfo&BillNum=2654) – "Steven A. Geller Autism Coverage Act."
o Last Action Taken in the Senate: Approved 39-0 and sent to the House
§ Text of bill approved (http://www.flsenate.gov/data/session/2008/Senate/bills/billtext/pdf/s2654e1.pdf)

Florida House:
· HB 1291 - Autism Spectrum Disorder
o General Information: click here: bill summary (http://www.myfloridahouse.gov/Sections/Bills/billsdetail.aspx?BillId=39122&BillText=autism&HouseChamber=H&SessionId=57&) – “Window of Opportunity Act”



o Last Action Taken in the House: Healthcare Council 4/22/2008 meeting
§ click here: webcast of 4/22/2008 Healthcare Council meeting (http://www.myfloridahouse.gov/Sections/Committees/committeesdetail.aspx?SessionId=57&CommitteeId=2348): see link “Committee Video Archives” in box at bottom right of web page
§ click here: Summary Analysis and Proposed Bill (http://www.myfloridahouse.gov/Sections/Documents/loaddoc.aspx?PublicationType=Committees&CommitteeId=2348&Session=2008&DocumentType=Meeting%20Packets&FileName=Healthcare%20Council4-22-08.pdf) (4/22/1008)


§ click here: Proposed Committee Bill (http://www.myfloridahouse.gov/Sections/Documents/loaddoc.aspx?PublicationType=Committees&CommitteeId=2348&Session=2008&DocumentType=proposed%20committee%20bills%20(pcbs)&FileName=PCB%20HCC%2008-27.pdf)
· The proposed House bill is now significantly different from the Senate bill, particularly:
o Insurance Coverage Mandate:
§ Amount: Includes the same $36,000 per year coverage mandate, but adds a lifetime limit of $108,000 (per person, per incident)
§ Effective Date: Delays the effective date of coverage mandate from 1/1/2009 until July 2010:

o Alternatives: Offers alternative mechanisms:
§ Insurance:
· Insurance Compact:
o Pending the effective date of the mandate, the bill delegates to a workgroup the legislative responsibility of formulating a solution. The workgroup is to study, propose and approve a compact that can be adopted by an insurance company to avoid the delayed coverage mandate.
o The compact would address penalties for noncompliance, disclosure to consumers, and the development of new insurance products to address such needs
o The workgroup would consist only of insurers, self-insured employers, and designees of the Governor, House and Senate. The Healthcare Council was encouraged to include a citizen representative, but so far has declined.
· Healthy Kids: expands coverage, effective 1/1/2009, by:
o Eliminating existing income cap purportedly making the coverage available to all Florida citizens
o Expanding benefits to include habilitative benefits such as PT, OT, speech therapy, and ABA
· Medicaid: Seeks to expand Medicaid state plan
§ State Education:
· Expands eligibility of McKay scholarships effective for 2012-2013 school year
· Creates VPK program offering early intervention services beginning with the 2012-2013 school year for children with IEP and otherwise eligible for VPK
· Assigns to CARD added responsibilities for establishing regional learning gateways within the seven CARD regions
o Applies to ASD children and children with other defined developmental disabilities
o The Healthcare Council was encouraged, but so far has declined, to:
§ change the name of CARD if responsibilities expand beyond autism
§ consider significant funding increases due to significant expansion of CARD’s responsibilities
§ Medical:
· Addresses expanded continuing education for healthcare professionals to increase ability to identify children with autism spectrum disorders and other developmental disabilities
§ Funding: not yet addressed (http://www.tbo.com/news/metro/MGBQ9PQDDFF.html)



§ click here: final Committee Action (http://www.myfloridahouse.gov/Sections/Documents/loaddoc.aspx?PublicationType=Committees&CommitteeId=2348&Session=2008&DocumentType=Action%20Packets&FileName=HC_Action_04_22_08%20reduced%20.pdf) - reflected here:
· proposed bill passed 18-0
· proposed amendments


§ Listing of all meeting handouts and action packets (http://www.myfloridahouse.gov/Sections/Documents/publications.aspx?CommitteeId=2441&PublicationType=Committees&DocumentType=All&Session=2008&SessionId=57) for Select Committee on Autism & Developmental Disorders


Richard in Florida
Father of twins born prematurely in 2004 after only 25 weeks; our son was diagnosed with ASD.

[Richard in Florida]

Many people want to know more about what is going on in the Florida legislature regarding treatment of children diagnosed with autism spectrum disorders. It is hard to keep up and the information is not easy to find.

I am posting some details (in four parts due to posting length limitations). I have included a number of links so that you can learn as much as you want. There is a lot to digest, particularly the complexities of the expanded House bill. Regardless of the outcome, you may want to dig into the details of what has happened this session.

Part 3: Summary of Autism Spectrum Disorder Bills in the Florida Legislature (last updated April 25, 2008 2:00 PM)


Other action of interest in 2008 Session

Florida Senate:
· Bill analyses by the Senate:
o Health and Human Services Appropriations Committee (http://www.flsenate.gov/data/session/2008/Senate/bills/analysis/pdf/2008s2654.ha.pdf) (04/10/2008)
o Health Policy Committee (http://www.flsenate.gov/data/session/2008/Senate/bills/analysis/pdf/2008s2654.hp.pdf) (04/03/2008)
o Banking and Insurance Committee (http://www.flsenate.gov/data/session/2008/Senate/bills/analysis/pdf/2008s2654.bi.pdf) (3/18/2008)

Florida House:
· Original House bill (http://www.myfloridahouse.gov/Sections/Documents/loaddoc.aspx?FileName=_h1291__.xml&DocumentType=Bill&BillNumber=1291&Session=2008)

· Bill analyses by the House:
o Committee on Health Innovation (http://www.myfloridahouse.gov/Sections/Documents/loaddoc.aspx?FileName=h1291a.HI.doc&DocumentType=Analysis&BillNumber=1291&Session=2008) (4/2/2008)
o Committee on Health Innovation (http://www.myfloridahouse.gov/Sections/Documents/loaddoc.aspx?FileName=h1291.HI.doc&DocumentType=Analysis&BillNumber=1291&Session=2008) (3/17/2008)

· Select Committee on Autism & Developmental Disorders:
o General Information About the Select Committee (http://www.myfloridahouse.gov/Sections/Committees/committeesdetail.aspx?CommitteeId=2441&sessionId=57): includes meeting handouts and action packets
o Webcasts of Select Committee meetings in April (http://www.myfloridahouse.gov/Sections/Committees/committeesdetail.aspx?CommitteeId=2441&sessionId=57): see links in box at bottom right of web page
o Committee materials handed out at meetings (http://www.myfloridahouse.gov/Sections/Documents/publications.aspx?CommitteeId=2441&PublicationType=Committees&DocumentType=All&Session=2008&SessionId=57)

· Speaker of the House press release announcing Select Committee (http://www.myfloridahouse.gov/Sections/Documents/loaddoc.aspx?DocumentType=Press%20Release&FileName=103): summary of Speaker Rubio’s proposals:

o Broaden Scope of Disabilities Covered: “The purview of the committee will be to consider ways to best utilize public and private resources to assist families in Florida with children coping with autism spectrum disorders or other developmental disabilities.”

o Increase Number of Citizens Covered: “While mandatory insurance coverage has been suggested as one solution, it is important to note that more than 50 percent of the health insurance sold in Florida is not subject to state mandates. . . . Policies that are subject to such mandates cover fewer than three million citizens.” This part of the story is complex, but essential to understanding why the Florida House and Senate cannot do more at this time:
§ ERISA State Law Preemption: The release addresses federal law (ERISA) that effectively invalidates state law mandates specifically applicable to employer sponsored health plans. To be effective, the mandates must specifically apply only to state regulated insurance companies that provide insurance to these health plans. See details in Part IV.

o Avoid Costly Mandates: “A costly mandate could jeopardize the ability of many to maintain their insurance.”

o Public Education Based Solutions: “Florida in the past decade has deliberately moved toward an educational system that offers flexibility and choice, both in early childhood education through the VPK program, and as children grow, through our public education system and the McKay scholarship program. Our challenge and your charge is to examine how to best meet the needs of children with autism spectrum disorders and other developmental disabilities that involve behavioral health disciplines and educational programs, and how these programs might best be funded.”


Richard in Florida
Father of twins born prematurely in 2004 after only 25 weeks; our son was diagnosed with ASD.

[Richard in Florida]

Many people want to know more about what is going on in the Florida legislature regarding treatment of children diagnosed with autism spectrum disorders. It is hard to keep up and the information is not easy to find.

I am posting some details (in four parts due to posting length limitations). I have included a number of links so that you can learn as much as you want. There is a lot to digest, particularly the complexities of the expanded House bill. Regardless of the outcome, you may want to dig into the details of what has happened this session.

Part 4: Summary of Autism Spectrum Disorder Bills in the Florida Legislature (last updated April 25, 2008 2:00 PM)

ERISA State Law Preemption

· ERISA State Law Preemption and Insurance Mandates: The Speaker's Select Committee press release indirectly addresses federal law (ERISA) that effectively invalidates state law mandates specifically applicable to employer sponsored health plans. To be effective, the mandates must specifically apply only to state regulated insurance companies that provide insurance to these health plans.

· Self-insured plans not subject to mandate: Many employers (typically larger employers who can afford it) self-insure the risk of their health plans. In these cases, insurance companies only administer the plans. Most employees are not aware of the difference. It is also difficult to ask the employer to confirm self-insurance without giving up privacy rights regarding existing medical conditions and risking lost coverage for otherwise covered costs.

· Fewer than 50% typically covered by mandates: Studies have shown that, overall, 45 percent of workers were covered by fully insured health plans and 55 percent were covered by self-insured health plans (see EBRI February 2008 Issue Brief (http://www.ebri.org/pdf/briefspdf/EBRI_IB_02a-20082.pdf)). It is not clear what portion of the 45% of insured plans is also not covered by either the FL Senate or the FL House bills. Both bills specifically exclude insurance carried by health plans of small employers (undefined) or individual insurance.

· ERISA Preemption Explanation: ERISA is a federal law that was initially proposed to protect beneficiaries of employer sponsored pension plans. The law was drafted much more broadly to cover all employer sponsored benefit plans, including health care plans, with a goal of seeking uniformity in the administration of plans by employers.
o A good summary of dilemma created by ERISA preemption is included on pages 22-24 of a summary (click here (http://frwebgate.access.gpo.gov/cgi-bin/getdoc.cgi?dbname=110_cong_reports&docid=f:hr374p1.110.pdf)) of a US House mental health parity bill (H.R. 1424 (http://frwebgate.access.gpo.gov/cgi-bin/getdoc.cgi?dbname=110_cong_bills&docid=f:h1424pcs.txt.pdf)):
§ “Understandably, large employers who operate in multiple states prefer a single unified system—with one set of rules with which they must comply and treat their employees. . . . The employer community has used the Employee Retirement Income Security Act (ERISA) as a shield against both federal and state health care protections.
§ “Only the most sophisticated legal and health care experts know that ERISA contains few health care standards. ERISA is primarily a pension law that establishes detailed standards for information, coverage, and funding of pension promises. While ERISA applies to all employer provided employee benefits, it does not generally contain minimum health care standards. Enacted in 1974, Congress expected that it would shortly adopt comprehensive federal standards. Congress has attempted to enact national health care standards on several occasions, but without success.”
§ “Further complicating the issue is the illogical treatment of ‘insured’ versus ‘self-insured’ plans. Under current judicial interpretation of ERISA, if an employer establishes a health plan and the employer is the insurer of the plan, then the states are generally preempted from regulating the health plan. However, if the employer contracts with a state licensed insurance company or other state sanctioned health care entity, then the state may directly regulate the behavior of the insurer or other entity, and indirectly affect the actions of the health plan. Despite the illogic of this regulatory scheme, in the absence of broader Congressional direction on comprehensive health care reform, H.R. 1424 continues this existing system of split federal versus state oversight of health plans and benefits.
o Generally, insurance companies and employers favor ERISA preemption (for example, ERIC fights to preserve the ERISA preemption (http://www.eric.org/forms/documents/DocumentFormPublic/view?id=E5F500000010))

· Good news pending in DC: More interestingly, H.R. 1424 (http://frwebgate.access.gpo.gov/cgi-bin/getdoc.cgi?dbname=110_cong_bills&docid=f:h1424pcs.txt.pdf) includes provisions to weaken ERISA preemption:
o Mental health parity bills typically apply to children with autism spectrum disorders because ASD is considered a mental illness under the Diagnostic and Statistical Manual of Mental Disorders DSM -IV-TR (fourth edition, text revision)
o H.R. 1424 (http://frwebgate.access.gpo.gov/cgi-bin/getdoc.cgi?dbname=110_cong_bills&docid=f:h1424pcs.txt.pdf) passed in the US House and was submitted to US Senate
o The US House bill currently in conference committee to address differences from Senate bill S.358 (http://thomas.loc.gov/cgi-bin/bdquery/z?d110:SN00358:) - apparently the conference committee may be close (http://www.individual.com/story.php?story=81329881) to reaching a compromise on the bill and the preemption provision may survive.


Richard in Florida
Father of twins born prematurely in 2004 after only 25 weeks; our son was diagnosed with ASD.

[Richard in Florida]

Update (April 30, 2008 10:00 AM)

The Florida House passed amendments to the Senate Bill late last night. To read the amendments, click here (http://www.flsenate.gov/data/session/2008/Senate/bills/amendments_Com/pdf/sb2654e1940817.pdf) (61 pages). The House plans to debate the amended Senate bill this morning. To watch the House session live click here (http://www.myfloridahouse.gov/Sections/SessionLive/preview.aspx) or click here (http://www.wfsu.org/ram/house.ram) - no scheduled time.

The House will then send the amended Senate bill back to the Senate for further debate. As you can see form the articles below, that debate should be interesting. To watch the Senate session live click here (http://mfile.akamai.com/18985/live/reflector:20997.asx) or click here (http://www.wfsu.org/ram/senate.ram) - no scheduled time.

Articles:

Tampa Tribune: House Leaders Head For Clash With Senate's Autism Measure (http://www2.tbo.com/content/2008/apr/30/me-house-leaders-head-for-clash-with-senates-autis/) – includes a summary of bill’s provisions

House Speaker Marco Rubio is "swinging for the fences" when it comes to his health insurance agenda, vowing Tuesday that he will negotiate all night, every night if needed to pass his version of legislation to cover children with certain developmental disabilities. . . . Rubio denied taking an all-or-nothing approach, but said that he isn't willing to settle for anything short of "meaningful and comprehensive" reform.

Steve Geller, sponsor of a leaner Senate version, complimented Rubio's passion for the issue but said his approach is likely to backfire."I believe that they are more likely than not killing the bill and making sure no one gets anything," said Geller, Senate minority leader from Cooper City. . . . The House's plan sounds great, Geller said. "If they had only funded it." Geller predicts that Rubio's plan would reach up to 80,000 disabled children, many of whom might enroll in Healthy Kids - yet the bill identifies no source for resulting costs. "It's dramatically more expensive, and they haven't funded it," Geller said. "The Senate's not going to go along with that; we have an opportunity here to help thousands and thousands of children. We should do so - not say, 'We've got to get everything, or we'll settle for nothing.'"

news-press.com: Florida House leaders take stand on autism insurance coverage bill (http://www.news-press.com/apps/pbcs.dll/article?AID=/20080429/NEWS0120/80429029/1075)

“These are the options, to do a little or do it right,” House Speaker Marco Rubio said. “We want to do something meaningful and comprehensive. Anything less is a disservice.”

The standoff is likely to mean no bill at all, Geller said.

Richard in Florida
Father of twins born prematurely in 2004 after only 25 weeks; our son was diagnosed with ASD.

[t-bean]

So what is Speaker Rubio's deal with this? I always expect Republicans to move away from expanding government healthcare programs, and yet he is advocating the expansion of government-subsidized healthcare programs for the developmentally disabled (regardless of the income level of the parents who may have private, fully funded insurance) if I am understanding this correctly. Why is there this assumption that people with decent private, fully funded insurance programs and good incomes would want to buy into government healthcare?

Any way to take a look to see exactly how much campaign money this guy is getting from insurance related PAC's in Florida?

[Steve in Florida]

Any way to take a look to see exactly how much campaign money this guy is getting from insurance related PAC's in Florida?

It's public record, but many in House Leadership have recieved contributions from the insurance industry.

MY opinion:

The Speaker is trying to do 2 things here:

1) Really something good. He spoke at the 1st meeting of the Select Committee on Autism and told the story of his sister who is an ESE specialist in Dade County Schools. I believe he is sincere. By expanding and changing the Senate "insurance mandate only" Bill to include components that touch; early child care, public pre K, ongoing Dr training to screen for autism, McKay Scholarship expansion, a delayed insurance mandate, and several other components the House plan will affect many more families in a more comprehensive way.

2) Shield the insurance industry from a flat out mandate. In his defense the Senate Bill would cover 40 something% of the insured in the State. The House plan would eventually cover more citizens, however it gives the insurance industry an opportunity to come back next session and wiggle out of the mandate. The insurance industry has a very strong lobby, especially in the House and I believe this a real possibility.

For instance, recently Allstate "thumbed their nose" at the State over providing records to justify their rate increases. The insurance commissioner halted the sales of Allstate plans in Florida until they complied and they appealed.

That indicates a certain degree of arrogance and confidence in the insurance industry to go up against the State like that.

IMHO Steve in Florida

[t-bean]

It's public record, but many in House Leadership have recieved contributions from the insurance industry.

MY opinion:

The Speaker is trying to do 2 things here:

1) Really something good. He spoke at the 1st meeting of the Select Committee on Autism and told the story of his sister who is an ESE specialist in Dade County Schools. I believe he is sincere. By expanding and changing the Senate "insurance mandate only" Bill to include components that touch; early child care, public pre K, ongoing Dr training to screen for autism, McKay Scholarship expansion, a delayed insurance mandate, and several other components the House plan will affect many more families in a more comprehensive way.

2) Shield the insurance industry from a flat out mandate. In his defense the Senate Bill would cover 40 something% of the insured in the State. The House plan would eventually cover more citizens, however it gives the insurance industry an opportunity to come back next session and wiggle out of the mandate. The insurance industry has a very strong lobby, especially in the House and I believe this a real possibility.

For instance, recently Allstate "thumbed their nose" at the State over providing records to justify their rate increases. The insurance commissioner halted the sales of Allstate plans in Florida until they complied and they appealed.

That indicates a certain degree of arrogance and confidence in the insurance industry to go up against the State like that.

IMHO Steve in Florida

I ask as a non-Florida resident because I don't know much about how your state operates but something seems very off in the House in your state, having read what I have on this issue here and elsewhere. I'm glad the Speaker has a sister involved in early intervention, but it sounds like the House revisions are so broad that they can't possibly be enacted. The Autism Speaks endorsed insurance bills seem to be *lean and mean* and demonstrate that they can be enacted with little premiumn increase (less than 1% annually) for the average policy holder with caps and limits that would still be meaningful for most families. A good way to stymy the insurance industry being forced into covering services would be to bury it in a massive expansion of government programs that most repubicans would reject. Something stinks.

[Steve in Florida]

I ask as a non-Florida resident because I don't know much about how your state operates but something seems very off in the House in your state, having read what I have on this issue here and elsewhere. I'm glad the Speaker has a sister involved in early intervention, but it sounds like the House revisions are so broad that they can't possibly be enacted. The Autism Speaks endorsed insurance bills seem to be *lean and mean* and demonstrate that they can be enacted with little premiumn increase (less than 1% annually) for the average policy holder with caps and limits that would still be meaningful for most families. A good way to stymy the insurance industry being forced into covering services would be to bury it in a massive expansion of government programs that most repubicans would reject. Something stinks.

Your observations are correct on many points. In politics in general you can "load up" a bill in an effort to kill it.

The AS endorsed Senate insurance mandate is *lean and mean* and the House Bill much more expansive, but the House Bill is sponsored by Republicans and supported by the Speaker.

All 3 branches of Florida Government are Republican controlled.

A consensus of opinion from people I have been keeping in touch with seems to be that this issue has too much momentum, press coverage, work into it and political will to die this session.

The press coverage of this issue has much political posturing involved, I believe the House and Senate to be much closer to a compromise than the stories might indicate.

Not everything in the House Bill is costly and much is very good. Almost all the components of the House Bill came right from citizen testimony into the Bill. That's the way it's supposed to work but seldom does.

For instance, mandating that Dr's ongoing training in the diagnostics of autism came right from testimony the Committee heard over and over that their Pedi's had completely missed a dx even when presented with concerns. Too much "'lets wait and see" or "boys talk later than girls."

The House amended Senate bill should go to the Senate sometime today, that's when the real show should start.

Steve in Florida

[Steve in Florida]

At 2:29 today the House amended version of Senate autism / insurance Bill passed by a 117 to 0 vote.

This will now go to the Senate for their review.

Steve in Florida

[Floortime Repository]

I recently found this website and all though its not out of florida the guides are terrific. I posted this on my site for autism and sensory processing disorders. I also have rss feed readers going with current news research and bills on autism along with links for contacts to government officials.
We are awaiting to hear of inclission on Autism speaks. Our site is free and very huge. Please use our videos links what you can as a resource in your endeavers politically.

Here is the website that I gave ICDL, Play Project and as many of my nationwide Floortime schools, consultants.

http://www.insurancehelpforautism.com/

This site is the only I have found that gives you templates of letters to write waht to say to the insurance company and the codes. Like I said although its out of California the guides and help are fantastic and its done by a parent of course. You can check different codes to see what coverage you might be able to find from anotehr carrier.

my site is www.floortimerepository.com

[Richard in Florida]

Today is the last day of the 2008 regular session.

Just before noon, the Senate further amended (http://www.flsenate.gov/data/session/2008/Senate/bills/amendments/pdf/sb2654e1697284.pdf) the House bill by a 40-0 (http://www.flsenate.gov/cgi-bin/view_page.pl?Tab=session&Submenu=1&FT=D&File=session/2008/Senate/bills/votes/html/SSB26540502080026.html) vote with no debate. In the pre-session, Senate President Pruitt indicated that the budget, Cover Florida, and the autism bill were their top priorities today. After an hour and a half, the Senate addressed the bill. Senator Geller, sponsor of original Senate bill, complimented the house for their efforts, discussed the reasons why the Senate could not accept the broad changes to the Senate bill adopted by the House, and essentially went back to the Senate bill with few of the changes proposed by the House:

· He complimented the House on their passion and indicated his appreciation for their efforts to address children with other developmental disabilities

· Estimated 10 times more children would be covered after the House changes, but expressed concern that there was no examination by the Senate of the estimated cost impact to the State of Florida – which he estimated would be dramatic

· Indicated that the efforts to address developmental disabilities must start with autism and that, next year, the Senate and House should start early in the session to address additional needs of children with developmental disabilities

· Noted that the original Senate bill was an insurance mandate (with annual but no lifetime benefit limitations) to provide to children who have autism spectrum disorders critically necessary therapies, specifically including ABA which he noted was the state of the art therapy
o He referred to studies that indicated that limiting the mandate to autism would increase premiums only ¼ to ½ of 1% (0.26% to 0.47%)

· Expressed an intent to compromise with the House by accepting provisions in the proposed House amendments that had no immediate fiscal impact or would have a fiscal impact in the future without further study by the Senate, which resulted in these provisions:

o Insurance mandate: including these features:
§ Covers employer-sponsored, health benefit plans purchasing insurance policies and HMO contracts, but not,
· ERISA preemption: Does not cover self-insured, employer-sponsored, health benefit plans. As I explained in this forum earlier this week, the bill cannot cover these plans because of the federal law (ERISA) that prohibits state law mandates that address what an employer-sponsored, health benefit plan must cover. If such a plan chooses to buy insurance for employees in Florida, they must buy insurance that includes the mandated coverage. If they choose to self insure, today, the State of Florida can mandate no aspects of that plan. Nationwide, approximately 55% of such plans are self-insured.
· Small insurance pools: Does not cover insurance plans offered in the individual market, individually underwritten insurance plans, or insurance plans provided to a small employer (not defined).
· House members have stated in session that the combined effect of these exceptions is that only 13% of children in the state with developmental disabilities would be impacted by this insurance mandate. I do not know the source of this conclusion, which indicates that the small insurance pools exception and the uninsured population would include 33% of children with developmental disabilities.

§ Covers insurance plans issued or renewed on or after April 1, 2009

§ Added a $200,000 lifetime cap for autism related benefits rather than the $108,000 limits proposed by the House – acknowledging the need for 3-4 years of intense ABA and other therapies

o Insurance compact: as proposed by the House, including these features:
§ Must convene, by August 31, 2008, a workgroup to address a binding insurance mandate agreement that includes a representative of all health insurers, a representative of all HMOs, a representative of employers with self-insured health benefit plans (which are not bound to accept the compact), a representative of the House, a representative of the Senate, and two representatives of the governor, including a consumer advocate (the Senate added this advocate).
§ The insurance mandate excludes any insurance company that signs this compact.

o Medicaid: Seeks to expand the Medicaid state plan, as proposed by the House, including coverage for autism spectrum disorder and Down syndrome and annual coverage limits of $36,000 and lifetime benefit limits of $108,000.

o Excludes all other features of the proposed House amendments, which he estimated would cost the State of Florida at least $100 million. Excluded features include:
§ VPK changes
§ Healthy Kids coverage
§ Expanded eligibility of McKay scholarships
§ Continuing education for healthcare professionals to increase ability to identify children with autism spectrum disorders and other developmental disabilities

The action now shifts back to the House - no scheduled time. Currently, they are honoring Speaker Rubio rather than addressing legislation. Both the House and Senate have spent a number of hours this week doing that. To watch the House session live, click here (http://www.myfloridahouse.gov/Sections/SessionLive/preview.aspx) or click here (http://www.wfsu.org/ram/house.ram). To watch the Senate session live, click here (http://mfile.akamai.com/18985/live/reflector:20997.asx) or click here (http://www.wfsu.org/ram/senate.ram).


Richard in Florida

[Richard in Florida]

Update (May 2, 2008 5:10 PM)

Just before 3:00 p.m., by a 118-0 vote (http://www.flsenate.gov/session/index.cfm?Mode=Bills&SubMenu=1&BI_Mode=ViewBillInfo&BillNum=2654), with no debate, the House counter-offered (http://www.flsenate.gov/data/session/2008/Senate/bills/amendments/pdf/sb2654e1711507.pdf). It appears that the House accepted the Senate’s proposed changes to the insurance mandate provisions and the insurance compact provisions and the Senate’s rejection of the other provisions of the proposed House changes, but insisted that the Senate add to the insurance mandate provisions and the insurance compact provisions all other developmental disabilities originally addressed by the House proposals.

At 5:06 p.m., the Senate sent a message to the House that they refused to accept (http://www.flsenate.gov/session/index.cfm?Mode=Bills&SubMenu=1&BI_Mode=ViewBillInfo&BillNum=2654) their counter-offer.

Stay tuned.

[Richard in Florida]

Update (May 2, 2008 6:00 PM)

As the last order of business for the session, the House approved (117-0) (http://www.flsenate.gov/session/index.cfm?Mode=Bills&SubMenu=1&BI_Mode=ViewBillInfo&BillNum=2654) the Senate version of the bill (http://www.flsenate.gov/data/session/2008/Senate/bills/amendments/pdf/sb2654e1697284.pdf).

Next step, Governor Crist.

Richard

[scorpiomom]

Hi Richard and Steve,
Hi Fellow Floridians! thank you to both of you for posting updatesre:Sb 2654/HB 1291.
Scorpiomom

[boggeymann]

I would like to thank Steve for keeping us Informed during this long process. I have 1 question when would this take efffect april 1, 2009?

[Steve in Florida]

I would like to thank Steve for keeping us Informed during this long process. I have 1 question when would this take efffect april 1, 2009?

Here's a pretty objective review of the Bill. I haven't had a chance to digest what exactly passed yet.

As the author says, until the "meat" of the insurance components takes effect the insurance indusrty will do their best to wiggle out of this one, and they will be very busy starting tomorrow towards that end.

The video archive of the last day has not been posted yet on the Florida House site, but when it is the last hour of the House session is pretty interesting, especially Speaker Rubio's closing remarks before the last vote.

Steve in Florida


http://www.ffddnews.com/articles0b.php?art_id=2008050218361752

AUTISM BILL PASSES FLORIDA LEGISLATURE - ADVANCES TO GOVERNOR
Susan Goldstein, FFDD News
Miracles do happen!

In the final emotional minutes of the 2008 Legislative Session, the typical drama that accompanies legislators’ 'must pass' bills had proponents of their measures on the edge of their seats. Autism Bill proponents feel insurers in Florida have been getting a free ride for far too long. Coverage for treatment of therapeutic interventions for Autism has been denied to thousands of children, while legislation was filed, fought, and died every year since 1997.

The insurance industry will now be forced to cover treatment, albeit with a few years of reprieve. This year they met their match. The national autism organization 'Autism Speaks' hired it’s own powerful lobbyists to push the measure. The Autism bill amazingly survived after it was amended twice and bounced from the House to the Senate Chamber five times, each body firmly standing their ground.

House proponents fought to include measures that would provide immediate relief to families of children with all disabilities, and to spread the financial burden and responsibility of treatments to include State Agencies. The House version included services to be provided by the Agency for Persons with Disabilities, Department of Children and Families, Department of Education and the Voluntary Pre-K program. Representative Andy Gardiner united the Chamber and they unanimously stood their ground until the last minutes of the session, when an unprecedented number of members crowded around the House Speaker Marco Rubio at the rostrum, with mikes turned off.

Their final decision to concur with Senator Geller's amended version of SB 2654 was their last, just prior to Sine Die. Speaker Rubio's last legislative directive almost brought him to tears and was one of disappointment. He sadly announced that the bill would only seek to cover 14% of the children in the state and urged his colleagues returning to the House or the Senate to 'finish the job'.

Coming under the relentless muscle and efforts of parents, advocates, and organizations, the Florida House took its first step towards requiring insurance companies to cover therapy for autism spectrum disorder. The compact requires the insurance companies to come to the table and negotiate specific coverage for children with Autism. They must agree to provide therapeutic intervention deemed ‘medically necessary’ by April of 2010. The legislation outlines the types of coverage and provides for determination of penalties for denials. The Office of Insurance Regulation is required to convene an advisory work group prior to the finalization of the compact.


The bill also establishes the authority for the Agency to pursue an application for a fourth Federal 'Home and Community Based' Medicaid waiver to cover therapeutic intervention for children with Autism and Down syndrome, up to age five. This waiver was unfunded, meaning no specific appropriation was provided for implementation of this measure.

Currently, there are over 16,000 people on a waiting list for the existing Home and Community Based Waiver, for which funding was drastically cut. This session, a $120 million cut came just after a $60 million cut during the July special session. Over $180 million in cuts during the past year equates to a more than 20% reduction and will delay, reduce, and eliminate services to over 8,000 developmentally disabled people across the state.

President of the Autism Society of Florida, Ven Sequenza was disappointed that the Kid Care 'buy-in' for autism treatments, including ABA, which was funded with $38 million new dollars and created 13,000 slots was stricken from the autism bill. Advocates for ‘income eligible’ children fought this measure claiming that a child with autism or a ‘DD eligible’ child would take up 10 slots vs. 1 slot for a healthy kid. Two additional options which are currently funded by the Department of Education were also stricken from the bill. They included language to use McKay Scholarships for Applied Behavior Analysis, speech and occupational therapy, and the elimination of the required one year wait or 'failure' in a public school. The option to use VPK dollars for therapeutic intervention was also deleted.

Mr. Sequenzia promises advocates will remain vigilant as the length of the negotiation process with the insurance industry will provide plenty of opportunity to mitigate or thwart the new legislation. As they always say, 'the devil will be in the details'.

Source: FFDD News

Date: May 2, 2008

[Steve in Florida]

here's what the Florida Insurance Council has to say about coverage for autism:

Steve in Florida


http://www.flains.org/content/view/1351/51/

Autism & Other Mandates
FIC opposes any benefit or provider mandate, including, but not limited to:
Autism - Mandated educational/health care treatments for autism are federally mandated and are the responsibility of the state. Shifting the responsibility to health insurers would further increase costs for all insured Floridians. Additionally, autism is not a rehabilitative condition; it may be treated but not cured.
Cystic Fibrosis,
Congenital craniofacial anomalies,
Surgical first assistants,
Infant eye examinations,
Lyme Disease out-of-network and investigative care,
Diabetes screening,
HPV vaccine and
Shingles vaccine.

With most of the proposed mandates, including autism, the state determines what is appropriate health care and what should be covered by insurers when, in most cases, these conditions do not affect or impact the vast majority of Floridians, and, if enacted, would drive up health care/medical costs for Florida’s employers and consumers. And mandates do not benefit the growing number of Floridians with individual health insurance since their coverage is underwritten.

In general, we support additional health insurance choices at less cost. Florida’s health insurers are offering more choices for coverage and benefits, and we don’t support legislation that limits choice or availability of health insurance, benefits or coverage for Floridians.

[BrendaLee]

... Additionally, autism is not a rehabilitative condition; it may be treated but not cured ...

This is sooooooooo offensive to me!! :mad:

Rehabilitative, as I understand it, means: to restore to good health or useful life, as through therapy and education.

As in ... Oh my Gosh, their child sustained a head-injury in a car accident ... thank goodness their health insurance company is going to provide rehabilitative services so the child can regain some of their previous functioning level.

Or perhaps this ... I read the other day that a guy is going to prison for shaking his baby so severely that the child now has brain damage. Thank goodness the Mother's insurance policy is going to cover rehabilitative services like Speech/Language, Occupational and Physical Therapy.

Ughhhhhhhhhhhh!! :mad: :( :confused: :( :mad:

Why is Autism viewed any differently? These children, in these two examples, would qualify for ESE services through the school system as well but that doesn't release the insurance companies from their responsibility of providing appropriate health care to address the child's needs.

IMHO, Autism is discriminated against because it remains defined as a Psychiatric Disorder.

I would really, REALLY LOVE to see Autism Speaks address this issue!! That, I believe, would solve a lot of the problems we encounter each day! :(

[Steve in Florida]

The video archive of the last day has not been posted yet on the Florida House site, but when it is the last hour of the House session is pretty interesting, especially Speaker Rubio's closing remarks before the last vote.



The video has been posted. This link below is for both Chambers, you want to watch May 2nd in the House at the very end. I was watching the House at the time and to see the reaction in the Senate today was interesting.

http://www.myfloridahouse.gov/Sections/HouseCalendar/broadcast.aspx

I hope Autism Speaks will listen to the words of Speaker Rubio and look beyond this session, look beyond the insurance only issue, look beyond just autism and be more inclusive of other developmental disabilities.

There were many very good no or low cost components in the House Bill that were left on the table. Most of them came right out of the House Select Committee on Autism and Developmental Disabilities from testimony presented by parents of children with autism. These components could have been included very easily but were not.

Steve in Florida

[Steve in Florida]

here is the final version of the Bill that passed last week:

http://w6.cloudspace.com/floridi_pub/files/Enrolled%20version%20SB%202654%20Children%20with%2 0Disabilities.pdf

Steve in Florida

[Dadvocate]

here is the final version of the Bill that passed last week:

http://w6.cloudspace.com/floridi_pub/files/Enrolled%20version%20SB%202654%20Children%20with%2 0Disabilities.pdf

Steve in Florida


Thanks for the hard work on this one, Steve. The old saw that 2 things you don't want to see made are sausages and law really rings true. I noticed a couple of slams of AS on some other threads re this legislation. I don't know the details but the reality is that bills are usually ugly compromises where no one really gets what they want all at once. It's an incremental process. I hope this is a good step for you Gators to build on. Good work. Our Illinois bill passed the Senate and is in the House SB 1900.

[Steve in Florida]

The old saw that 2 things you don't want to see made are sausages and law really rings true.

The more I've seen the last 3 years the less I want to know.

In the final minutes of the session the Speaker made a plea for the next session to re visit the issue. He will be termed out. His point was that once the Legislature takes up an issue there is an attitude that it was addressed and it can be difficult to re visit.

I am also suprised at how many people, especially people that should know better, think that the time to start working on this kind of project is at the beginning of the session.

The time to start on this project for the next spring of 09 session is today. Many Bills are heard in Committee before the session even starts, some by then are ready to come to the floor. Many Bills are put to bed by their sponsors in the Nov and Dec before the session.

The next sessions Leadership in both chambers and anyone not up for re election should be addressed now. Parents should be developing relationships with their Representative and Senator now as well as any other Legislator within an easy drive.

E-mails are good except for in session where they are often deleted and only the subject line noted. Phone calls are much better. A personal visit, especially with your child is 100 times better than either.

Good luck in the Land of Lincoln, I thought you were in Florida?

Steve in Florida

[Dadvocate]

The more I've seen the last 3 years the less I want to know.

Parents should be developing relationships with their Representative and Senator now as well as any other Legislator within an easy drive.

E-mails are good. Phone calls are much better. A personal visit, especially with your child is 100 times better than either.

Good luck in the Land of Lincoln, I thought you were in Florida?

Steve in Florida

Land of Obama today :) The advice above is very sound. I do an annual legislative visit with my son and keep in touch via calls or emails out of session.

[DoctorRobert]

I am a practicing behavior analyst in Florida and a member of The Florida Association for Behavior Analysis. I am responsible for developing downloadable podcasts for this organization. I am attempting to develop a podcast on this specific issue, namely, the passage of the Florida legislation on insurance funding for Autism therapies. I would consider it incomplete without the input of persons, families, and/or caregivers who are similarly impacted by this legislation.

Please contact me if you have questions, comments, or information you feel too important to not be included in the dissemination of info to practicing behavior analysts and the persons they serve.

FABA has many members from across the US and other countries, so the information would go well beyond the state borders.

Hoping to hear back from anyone with opinions, questions, or comments...

-Dr. Robert

[Steve in Florida]

from the Ft Lauderdale Sun-Sentinel: (Linda Kleindienst is the Tallahassee Bureau Head for the Sum Sentinel)

Steve in Florida

http://weblogs.sun-sentinel.com/news/politics/broward/blog/

Gov. Crist expected to sign autism bill in Broward

> Posted by Linda Kleindienst at 4:22 PM
Gov. Charlie Crist is expected to be in South Florida next week to sign the last bill that passed during the legislative session – a mandate for insurance companies to cover therapy sessions for children diagnosed with autism.

Championed by Senate Democratic Leader Steve Geller of Cooper City, the measure was thrown to the House on the last night of session to take or leave. House leaders had hijacked the autism bill filed by Rep. Ari Porth, D-Coral Springs, and wanted to add in children with developmental disabilities. But knowing the Senate was about to gavel business to a close, House leaders reluctantly opted to approve it.

The scene was high drama. Senators stood on the Senate floor, watching a TV screen in the front of their chamber that showed huddled House leaders trying to make a decision, knowing it was quickly reaching 6 p.m. and the Senate was about to adjourn the 2008 session.

“With all the high drama, they need to do a made-for-TV movie,” said Geller. “But Tom Selleck and Burt Reynolds are too old to play me. And Tom Cruise is too young. We may have to cancel that idea because we can’t find a 50-something leading man.”

As of now, the bill signing is scheduled for 2 p.m. next Tuesday at the Center for Autism Related Diseases at Nova Southeastern in Davie.

[Steve in Florida]

Hello fellow parents,

There will most probably be much political backslapping and
handshaking with much congratulating for a job well done.

I would urge anyone going to give credit where credit is due, however
to reserve their praise with a reminder that this should be viewed as
only a first baby step. In my opinion any undo praise from us parents
will just make it harder to revisit the issue next session and there
is still much to do.

When it comes to politicians and insurance companies – your gratitude will be mistaken for satisfaction, and your kindness will always be mistaken for weakness.

The Bill as written does not cover a majority of autistic children,
it does not cover any of them right now, and it has several loopholes
for the insurance industry to exploit. You can be sure that the well-
financed insurance lobby will be trying to wiggle out of this next
session.

The House version, while softer on the insurance industry than the
Senate version, had many provisions beyond insurance that offered
more comprehensive help for these children.

I hope in the next session there will be Bills that will expand on
what the House offered and that there will be an expansion of the
insurance provisions that just passed. The time for parent lobbyist's
to start contacting their Representatives and Senators starts Tuesday.

Steve in Florida

[Richard in Florida]

I would urge anyone going to give credit where credit is due, however to reserve their praise with a reminder that this should be viewed as only a first baby step. In my opinion any undo praise from us parents will just make it harder to revisit the issue next session and there is still much to do. When it comes to politicians and insurance companies – your gratitude will be mistaken for satisfaction, and your kindness will always be mistaken for weakness.

Well said Steve!!!

Good morning.

A significant percentage of Florida’s citizens are beneficiaries of employer sponsored heath plans and other health insurance policies that will be exempt from the coverage mandates in this legislation. It will be difficult for most families to determine if this legislation will actually help them. Some have estimated that only 14% of those with insurance coverage will actually benefit from the mandated insurance coverage in this legislation. Accurate data to support such estimates is hard to find. Learning whether you are covered may be even more difficult.

Senator Geller, the bill’s sponsor, should be proud of what he accomplished, but not too proud. Much more can be done to help children with autism spectrum disorders. Only some of these efforts would require state funding. It is important that the legislation’s supporters get credit for what they have done, so far. It is also essential that their constituents understand the legislation’s limitations and the work yet to be done. You may be disappointed or even angry if you learn that this legislation will not help your child or your family. You may be particularly upset if you praise your representatives, and then learn that they have not accomplished as much as you thought. I suspect that many families will learn for the first time that the bill does not apply to them when they submit a claim that is rejected as not covered. In most cases, parents may blame only the insurance company, thinking incorrectly that the rejection is noncompliance. The answer is much more complex.

Parents should communicate their interest in continuing reform to their representatives. Personal contact works best, either by phone or personal visits with your children. Emails work, but not as well, particularly during the session. The best time to contact your representatives is today. Let them know early and often that you have needs that this legislation did not address. If you wait until the session starts in 2009, it may be too late. Much of the work on new legislation for 2009 will take place during the fourth quarter of 2008 (October through December). To get on the agenda, you need to start today.

If you live nearby, try to attend the bill signing and let Governor Crist and others in attendance know that you appreciate their efforts and that they need to accomplish much more before the end of the 2009 session.

Richard in Florida

[Steve in Florida]

For those interested there will be ceremonial Bill Signings all over the State, all tomorrow May 20.

Steve in Florida


(times subject to change):



GOVERNOR



10:00am-10:30am AUTISM BILL SIGNING

Location: The Capitol

Address: 400 South Monroe Street

Tallahassee, FL 32399



12:10pm-12:40pm AUTISM BILL SIGNING ORLANDO

Location: Quest Kids

Address: 500 East Colonial Drive

Orlando, FL 32803



2:15pm-2:45pm AUTISM BILL SIGNING FT. LAUDERDALE

Location: Baudhuin Preschool

Address: Mailman Segal Institute for Early Childhood Studies

Jim & Jan Moran Family Center Village

Nova Southeastern University

7600 SW 36th Avenue

Ft. Lauderdale, Florida 33314



LT. GOVERNOR





9:00 am - 9:45 am AUTISM PRESS CONFERENCE

Location: Jericho School

Address: The Jericho School

1351 Sprinkle Dr

Jacksonville, FL 32211



11:00 am - 11:45 am (CST) AUTISM PRESS CONFERENCE

Location: Sacred Heart Hospital/ Children's and Women's Hospital

Address: 5151 N. 9th Avenue

Pensacola, FL 32504



3:30 pm - 4:00pm AUTISM PRESS CONFERENCE

Location: The John Maxwell Biasco Autism Resource/

Center for Autism & Related Disabilities – USF

Address: 10501 FGCU Blvd. South, Modular B

Ft. Myers, FL 33965

[Richard in Florida]

There are the three key components of the Florida autism spectrum disorder legislation: an insurance mandate, an insurance compact, and a Medicare waiver for developmental disabilities. This post covers the insurance mandate:

Q: Will the autism insurance mandate help my family?

A: Speaker Rubio estimated that this mandate would cover only 14 percent of children with an autism spectrum disorder (http://www.news-press.com/apps/pbcs.dll/article?AID=/20080502/NEWS0120/80502022/0/NEWS0110). It is hard to find data supporting this or any other coverage estimates. Yet, it is clear that this mandate will not help a significant majority of Florida’s citizens.

While this legislation is an important first step, it was a very small step. Much more can be done. Please encourage your legislators to continue the battle they have only just begun to fight – the battle to give our children a realistic opportunity to lead a normal life.

Q: What health benefit plans are covered by the mandate?

A: The legislation generally requires mandated coverage from:
·Group health insurance (http://www.autismspeaks.org/community/forums/Health%20insurance) plans provided by an insurance company, which includes the group insurance program (http://dms.myflorida.com/human_resource_support/state_group_insurance) for state officers and employees
·Group health maintenance contracts provided by a health maintenance organization (http://en.wikipedia.org/wiki/HMO) (HMO)

Q: What health benefit plans are not covered by the mandate?

A: Insurance companies and HMOs can secure an exemption by signing, no later than April 1, 2009, the developmental disabilities insurance compact included in the legislation. There are a number of other exemptions, including self-insured plans, any health insurance plan offered in the individual market, any health insurance plan that is individually underwritten, and any health insurance plan provided to a small employer. I will post more details soon.

Q: When will the mandate be effective?

A: The mandate only applies to contracts issued or renewed on or after April 1, 2009. Employers can change their plan structure before the effective date so that the mandate does not apply.

Q: Who is eligible for services covered by the mandate?

A: Individuals must have been diagnosed as having a developmental disability at 8 years of age or younger and must either be under 18 years of age, or be 18 years of age or older and in high school.

Q: Are there any limits on the amount of services covered by the mandate?

A: The legislation requires minimum coverage for diagnosing and treating autism spectrum disorders in the amounts of $36,000 annually and $200,000 total lifetime benefits.

Q: What services are covered by the mandate?

A: The mandate specifies general categories of treatment and diagnostic services related to autism spectrum disorders (http://www.nimh.nih.gov/health/publications/autism/complete-publication.shtml) (defined as: autistic disorder, Asperger’s syndrome, and PDDNOS (http://www.psych.org/MainMenu/Research/DSMIV/DSMIVTR/DSMIVvsDSMIVTR/SummaryofPracticeRelevantChangestotheDSMIVTR/PDDNOS.aspx) as defined in the most recent edition of the Diagnostic and Statistical Manual of Mental Disorders of the American Psychiatric Association):
·Treatment: speech therapy, occupational therapy, physical therapy, and applied behavior analysis (ABA)
oTreatment plan: must be prescribed by the treating physician and must include information necessary to pay claims, such as diagnosis, proposed treatment by type, frequency and duration, anticipated outcomes/goals, and frequency of updates
oABA services: includes a specific definition
·Diagnosis: Well-baby and well-child screening for diagnosing the presence of autism spectrum disorder

Habilitative Services: The legislation provides that “Coverage may not be denied on the basis that provided services are habilitative in nature.” The Florida Insurance Council says “autism is not a rehabilitative condition; it may be treated but not cured.” (http://www.flains.org/content/view/1351/51/) Apparently, some health insurers have denied coverage for treatment of an autism spectrum disorder, stating that the insurance policy only covers rehabilitative services.

Service Parity: The mandated coverage may not be subject to dollar limits, deductibles, or coinsurance provisions that are less favorable than similar provisions applicable to physical illnesses otherwise generally covered.

Q: Are any services excluded from the mandate?

A: The legislation permits certain coverage exclusions, including:
·restrictions on services provided by family or household members
·participating provider requirements (http://en.wikipedia.org/wiki/Preferred_provider_organization): that limit coverage to providers who agree to provide plan services, typically at a substantial discount below regularly-charged rates
·utilization review (http://en.wikipedia.org/wiki/Utilization_review) of health care services, including the review of medical necessity (http://en.wikipedia.org/wiki/Medical_necessity), case management (http://en.wikipedia.org/wiki/Case_management), and other managed care (http://en.wikipedia.org/wiki/Managed_care) provisions
·coordination of benefits between two or more group health insurance policies

Coverage may not be refused for medically necessary services, and contracts for coverage may not be refused (new and renewal), terminated or restricted, for an individual because the individual is diagnosed as having a developmental disability.

Richard in Florida

[mkgmt]

My son just separated from the Navy in Florida. He has always claimed Florida as his home state. He is continuing with Humana insurance through the military's version of COBRA. My grandson and his mother live with me in Tennessee. My grandson is 6 years old and is diagnosed with Mode