Thursday, June 28, 2012

Affordable Care Act upheld. What does that mean for Utah?



Today the Supreme Court upheld the Affordable Care Act in a ruling of 5 to 4.  What does this decision mean for autism insurance coverage in Utah?

Lawmakers in Utah have indicated plans to file a certificate of exemption, which would allow Utah to define our own ‘essential benefits package’.  If we want evidence-based treatments for autism included in this ‘essential benefits package’ we must act NOW!  All it takes is 3 minutes of your time, right now. If you have already submitted your comments, please encourage your friends and family to comment as well.

Copy and paste the following letter into your email and send it to LRammell@Le.Utah.gov.  Make sure to include your own comments and personal story. Post done below so we know who to thank. Together we WILL get autism insurance coverage in Utah!





Dear Utah Health System Task Force:

I am writing to ask you to please include evidence-based treatment for autism in the essential benefits package for Utah. Currently, Utah leads the nation in autism prevalence rates with 1 in every 47 children having some form of autism spectrum disorder. With treatment, 47% of children with autism can achieve normal intellectual functioning as opposed to just 2% of children who are left untreated. With treatment, 80-90% of children receiving evidence-based treatment show significant improvement of their autism symptoms.

[Insert personal experience here, if desired.]

Including evidence based treatment for autism in the essential benefits package is relatively inexpensive - just $0.44 - $0.83 per member per month. The average cost of caring for an untreated individual with autism over their life span is as much as $3 million dollars - most of which will be incurred in the later part of their lives. Providing coverage to treat autism in the early years of a person's life can save millions of dollars and result in independent adults that are able to contribute to the society in which they live rather than rely on others for their livelihood and well-being.

Currently there are 31 states with legislation requiring coverage for the treatment of autism. Aside from the basic humanity of caring for the children in Utah affected by autism, the state of Utah has an obligation to protect tax-payers from the expense of a large population of untreated individuals with autism. As a concerned Utah resident, I urge you to include evidence-based treatment for autism including behavioral health treatment, pharmaceutical care, psychiatric care, psychological care, therapeutic care (including occupational and speech therapy) and medical care.

Sincerely,

Jane Freeman [Insert your name]
121 Freedom Way [Insert your address]
Treatment Town, UT 84123 [Insert your city, state, zip]

Wednesday, June 27, 2012

Is evidence-based treatment for autism 'essential' for you?

Don't leave it to chance whether or not Utah lawmakers know treatment for autism is essential.
Submit your comments TODAY.
(Comment period closes 7/3/12)


Utah lawmakers are in the process of putting together their list of health benefits that are deemed essential for inclusion in the Utah health insurance exchange program. They are accepting public comments - and you can bet your bottom dollar the insurance carriers have weighed in heavily on this issue but where is the voice of the consumer?

You have until July 3rd, 2012 to provide your comments in writing to the Utah Health System Task Force. Please provide your comments indicating that evidence based treatment for autism is an essential benefit for you, your family and your community.

Please send your comments to LRammell@Le.Utah.gov.

After you have sent your comments:
  • Post DONE
  • Share on FB
  • Urge your friends, family and neighbors participate

Thank you!
Below is a sample letter for you to use as a starting point. 
Be sure to modify it to your situation and insert your personal sentiments on the issue.


----------------------------------------------------------------------------------------------------------------------------------------


Dear Utah Health System Task Force:

I am writing to ask you to please include evidence-based treatment for autism in the essential benefits package for Utah. Currently, Utah leads the nation in autism prevalence rates with 1 in every 47 children having some form of autism spectrum disorder. With treatment, 47% of children with autism can achieve normal intellectual functioning as opposed to just 2% of children who are left untreated.  With treatment, 80-90% of children receiving evidence-based treatment show significant improvement of their autism symptoms.

[Insert personal experience here, if desired.]

Including evidence based treatment for autism in the essential benefits package is relatively inexpensive - just $0.44 - $0.83 per member per month. The average cost of caring for an untreated individual with autism over their life span is as much as $3 million dollars - most of which will be incurred in the later part of their lives. Providing coverage to treat autism in the early years of a person's life can save millions of dollars and result in independent adults that are able to contribute to the society in which they live rather than rely on others for their livelihood and well-being.

Currently there are 31 states with legislation requiring coverage for the treatment of autism. Aside from the basic humanity of caring for the children in Utah affected by autism, the state of Utah has an obligation to protect tax-payers from the expense of a large population of untreated individuals with autism. As a concerned Utah resident, I urge you to include evidence-based treatment for autism including behavioral health treatment, pharmaceutical care, psychiatric care, psychological care, therapeutic care (including occupational and speech therapy) and medical care.

Sincerely,

Jane Freeman [Insert your name]
121 Freedom Way [Insert your address]
Treatment Town, UT 84123 [Insert your city, state, zip]

What should Utah’s ‘bare minimum’ health plan cover?

By Kirsten Stewart
First Published Jun 18 2012 11:23 am • Last Updated Jun 19 2012 07:39 am


"Amid uncertainty over the fate of federal health reform, Utah is taking steps to implement parts of the law.

Topping the "to-do" list this week: defining the "essential benefits" package, or bare minimum of health benefits mandatory for all policies sold on Utah’s online health exchange — seen as the primary path to coverage in the future."

Tuesday, June 19, 2012

PEHP Pilot Program Update for Participants

PEHP sent out letters this week to program applicants for the PEHP Autism Pilot Program. If you applied and do not receive any notification of acceptance into the program this week (or other correspondence indicating you have been declined or that you will need to supply additional information) you will need to call them right away. The program is set to begin reimbursement of ABA services on July 1st, 2012.

For those accepted into the program, you should have received information regarding providers that have already been pre-screened and authorized for use in this program. If you already have a provider of choice that is not on the list you received, you will need to submit their information to PEHP for authorization for reimbursement of services through this program. If you do not have a provider selected, you can call those on the pre-screened list sent to you and negotiate a program with that provider. If you have questions don't hesitate to ask!

PEHP - Public Employees Health Program

Monday, June 18, 2012

Without insurance for autism, Utah families leave state

Without insurance for autism, Utah families leave state: 

http://www.sltrib.com/sltrib/news/54254286-78/autism-insurance-utah-state.html.csp


Something very real and tragic is happening to Utah families forcing them into some very difficult decisions. SelectHealth is behind the times in their statement that they will not willingly cover treatment for autism because it's plans "are intended to cover medical needs, rather than to modify behavior or achieve educational objectives"

Given the recent advisement from the federal advisory board on the issue, it seems that they should be adjusting their policy on autism treatment: “The OPM Benefit Review Panel recently evaluated the status of Applied Behavior Analysis (ABA) for children with autism. Previously, ABA was considered to be an educational intervention and not covered under the FEHB Program. The Panel concluded that there is now sufficient evidence to categorize ABA as medical therapy. Accordingly, plans may propose benefit packages which include ABA.”

From Brian Eliason, father of a child with autism: "It was hard enough to discover that he had autism, but then it was just an added burden to know we didn’t have a way to financially take care of him unless we left the state."

Is this how Utah legislators and residents want to treat families of children with autism? Are we a family friendly state as long as your child doesn't have special needs or medical conditions we don't want to cover? This is not how I want my state represented, how about you?

Friday, June 8, 2012

Success depends on your backbone, not your wishbone


I saw this online this morning and thought it applies very well to the Utah autism advocacy community. If we are to have autism insurance reform in Utah we must use our backbone AND our wishbone. We use our wishbone a lot online as we share, like and comment on the issue through social media. We have to keep our wishbone alive or we will shrivel. But we can't forget that we also have backbones...

We also are going to need to exercise our backbones by participating in meetings, making phone calls and doing the work that will bring the issue to the forefront of our legislature.

We are currently working on meetings with legislators to educate them on autism issues. If there is one in your area, please make sure you attend. If there is not one that you know of, please join in and help us set one. Legislators that are running for election or re-election right now are keenly interested in your feedback about how they vest serve you as an elected politician. Have you spoken to them about autism insurance reform? If not, your backbone isn't quite in use yet and your wishbone may give out soon. Act today - even if it is simply to ask what you can do in 30 minutes a week, use your backbone and help us move this mountain.