The lives of thousands of Colorado’s autistic children and their parents just got a little easier — and it’s about time. On July 1, Colorado became the 12th state in the nation to reform insurance coverage for children with Autism Spectrum Disorders (ASD). It is now state law that private group health insurance providers cover a range of treatments — including speech and physical therapy — for patients with ASD.
The law, known as HIMAT (Health Insurance Mandated Autism Treatment), prescribes applied behavioral analysis (ABA) as the legally mandated treatment approach.
ABA aims to teach socially acceptable behaviors, such as appropriate eye contact, to give autistic kids a better shot at developing into higher-functioning adults. These pragmatic therapies must be delivered by certified specialists, and parents can now appeal to the Division of Insurance if a company denies treatment.
“This is a tremendous step in the right direction for families who have been devastated by this diagnosis,” said Dr. David Hatfield, director of the Colorado Coalition of Autism Professionals, which helped design the law.
The Centers for Disease Control and Prevention says autism affects one in 110 children. Hatfield estimates at least 10,000 autistic kids are covered by group health insurance plans in Colorado. Unfortunately, HIMAT will not benefit autistic children who don’t have health care coverage, or who have coverage through certain private non-group plans.
Implementing this law will not be cheap for insurance companies, costing up to $34,000 per year in treatment for each patient age 8 and under, and $12,000 in annual coverage for each patient between the ages 9 to 18. Insurance companies are understandably worried about the precedent HIMAT may set for lawmakers to mandate the kind of treatment health care providers give certain patients. Historically, physicians decide what’s appropriate.
Considering how many families are impacted by autism, it’s a shame insurance companies failed to take a pro-active approach, and instead had to be forced into action. To their credit, they now appear to be embracing the law.
“We put together a task force to prepare once the legislation passed,” explained Dr. Susan Pharo, chair of pediatrics for Kaiser Permanente Colorado. So far this is the only state in Kaiser’s operating realm to enact such a law. “These families have really needed access to coverage, so this is a huge step forward.”
Pharo says children with autism lack the natural ability to learn communication skills in normal social settings. They need to be trained how to appropriately respond and reciprocate. “Research shows when you can provide early interventions, the outlook for patients to enjoy a much more rich life is greatly enhanced.”
Pharo says Kaiser has notified more than 500 members that treatment plans now will be provided to those who are eligible. Chris and Nikki Harem of Westminster received notice from Kaiser for their 13-year-old son Nevan and 9-year-old son Reice. “They sent us a letter for both boys saying services will be available if they qualify,” Chris Harem said.
Harem’s sons were both diagnosed through JFK Partners at Children’s Hospital, an organization that evaluates patients with developmental disabilities. The Harems have since been frustrated with the lack of services covered by Kaiser.
In the meantime, they’ve found social support through the Autism Society of Colorado, meeting other families with autistic children at events like the annual picnic in Washington Park last month. Dozens of families enjoyed a summer day without worry of judgment or misunderstandings.
Since 2007, American Academy of Pediatrics guidelines have called for screening all children for autism at 18 months and 24 months. It’s outrageous to think how many children with autism have been missed or have been diagnosed but given little or no special health care treatment.
Some insurance companies have been known to drop kids after an autism diagnosis, according to Dr. Hatfield. Those children were unable to get new coverage because of their “pre-existing condition.” Parents were forced to pay out of pocket for treatments, or make do with none at all.
When you consider that more than one-third of autistic toddlers display self-injurious behavior, and nearly all have abnormal cognitive abilities with many unable to speak, you can start to appreciate how desperate the families of these children have been for help.
HIMAT makes Colorado one of the most pro-active states in addressing the needs of autistic kids. Similar laws exist in Montana, Nevada, Arizona, New Mexico, Texas, Louisiana, South Carolina, Florida, Illinois, Indiana, and Pennsylvania. Several other states have pending legislation.
This patchwork of progress has been pushed by parents and advocacy groups, like the Autism Society of Colorado, which the Denver Metro Chamber of Commerce recently named best small non-profit organization of the year.
Betty Lehman, ASC’s executive director, is hopeful Colorado is finally on the right track. “Colorado is the worst service state in the nation, despite being seventh in per capita income, because of budget constraints due to TABOR,” Lehman stated.
That is why ASC and the Colorado Coalition of Autism Professionals chose to pursue help through private insurance sources.
Autism has no cure, but the earlier children get help, the better their lives can be.
-Guest blogger Kristen Kidd is raising two sons in Highlands Ranch and writing a screenplay about Kathryn and George “Machine Gun” Kelly.
Author: Mile High Mamas
