Monday, August 28, 2006

South Carolina's Medicaid Pilot Project for Children with PDD


Hello everyone! After a long summer hiatus, I have some news to report on Ryan’s Law.

As many of you know and thanks to your efforts, we DID PASS some autism legislation this year – yippee! Unfortunately, it wasn’t the insurance mandate we wanted, but there’s still good news. Here’s what happened:

The original Ryan’s Law bill, which would have required insurance coverage for autism, was “replaced” with a PDD pilot program. The pilot program passed and will be funded with $3 million of state money, matched by federal Medicaid funds. Although we are disappointed that the insurance mandate didn’t make it this year, we are excited about and grateful for the PDD pilot program. As with any government program, there will be a fair amount of red tape and restrictions to deal with, but we are hopeful that it will provide some meaningful funding for therapy starting in 2007.

The PDD pilot program will be run through the S.C. Department of Disabilities and Special Needs. DDSN has been meeting with the Department of Health and Human Services, the Department of Education, and other interested parties (including a few parents) all summer to work on setting up the pilot program. A major step in the process is getting federal approval of the Medicaid waiver, which basically means getting the federal government to approve how the money will be spent through the program. As part of the approval process, DHHS is required to hold a public meeting at which interested parties can comment on the proposed program. The public meeting will be held on Wednesday, September 13, from 5 to 7 p.m. at Two Medical Park, in the lower level conference room, Medical Park Drive, Columbia. (This is on the campus of Palmetto Richland Hospital.)

The legislation that creates the pilot project contains some restrictions on how the money will be spent (e.g., the child must have been diagnosed by age 8); the waiver application will contain more restrictions, and those will be discussed at the public meeting. The exact language of the legislation that creates the PDD pilot program is below.

Thanks again to everyone who helped create this new program for the children with autism in South Carolina. If you contacted your legislator, if you testified at a public hearing, or if you simply showed up to support the effort, then you contributed significantly to the passage of this legislation.

See you soon – Lorri Unumb, Ryan’s mom


“The three million dollars appropriated to the Department of Disabilities and Special Needs, as the agency authorized to treat autistic disorder, shall be designated for a Medicaid pilot project to treat children who have been diagnosed by eight years of age with a pervasive developmental disorder. The pilot project must target the youngest ages feasible for treatment effectiveness, treatment of each individual child shall not exceed three years without a special exception as defined in the waiver, and reimbursement for each individual participant may not exceed $50,000 per year. The Department of Disabilities and Special Needs and the Department of Health and Human Services will determine the areas of the State with the greatest need and availability of providers. Children participating in the pilot project will be selected based upon an application system developed in compliance with the Medicaid waiver. Treatment will be provided as authorized and prescribed by the department according to the degree of developmental disability. In authorizing and prescribing treatment the department may award grants or negotiate and contract with public and private entities to implement intervention programs for children who have been diagnosed with a pervasive developmental disorder. “Pervasive developmental disorder” means a neurological condition, including autistic disorder and Asperger’s syndrome, as defined in the most recent edition of the Diagnostic and Statistical Manual of Mental Disorders of the American Psychiatric Association. By June 30, 2007, the department shall report to the General Assembly and the Governor on the developmental progress of the children participating in the pilot project. This provision does not establish or authorize the creation of an entitlement program or benefit.”

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