Monday, June 25, 2007

Nice Coverage in Spartanburg Paper

Insurers soon required to cover tots' treatment

ASHLEI N. STEVENS,
Staff Writer
Published June 25, 2007

Brady Verett is all smiles and giggles as he reads the words "girl," "star" and "pig," matching the written words with pictures.

The bubbly blond also has learned to write his name, he's potty-trained and is learning to dress and feed himself.

While these seem like typical tasks for a 3 1/2-year-old to handle, they are chores Brady might not be able to complete without the aid of special therapy, called applied behavioral analysis. He was diagnosed a year ago with autism, a neurobiological disorder that affects the ability to communicate and adapt to change. It usually lasts throughout a person's lifetime.

Research has shown that ABA therapy is the most effective for children such as Brady, teaching them basic language, sorting and identification concepts.

The results of ABA are positive, parents say, but the effects on the wallet are straining. Brady has 30 hours of therapy each week, and for most families, the cost ranges from $30,000 to $75,000 a year.

"There are some families that can afford that, but most middle-class folks cannot," said Brady's mother, Montie. "There are some families that go without the services because they can't afford it."

Relief is coming to families like the Veretts. A law passed earlier this month, known as Ryan's Law, will require private insurance companies, beginning July 1, 2008, to cover children with autism and related therapies, providing up to $50,000 a year for children ages 16 and younger. That's money that no longer will have to come directly out of the pockets of families with autistic children.

"Families and children will have opportunities they never had before, and kids will get treatment they never had before," said Sen. Joel Lourie, D-Columbia, an avid supporter of Ryan's Law and one of the bill's sponsors. "In many cases, we've provided not only treatment, but hope, for thousands of children."

'Ryan's Grassroots Gang'
Ryan's Law was prompted by a Charleston mother and lawyer, Lorri Unumb. Her 6-year-old son, Ryan, is severely autistic.

Lorri and her husband are both lawyers who can afford the therapy costs. But it's still so expensive that they sold their house to move into a smaller home to cover costs.

"The average family income in South Carolina is $40,000," Unumb said. "If you're an average family trying to provide this therapy for your child, forget it."

In May 2005, as a professor at the Charleston School of Law, Unumb began researching insurance policies in other states that covered autism, and she decided to spearhead a movement in South Carolina. Hundreds of parents rallied together as "Ryan's Grassroots Gang," pushing for the bill to become law.

Their efforts proved successful in 2006, although the law that passed didn't match the original intent that Unumb and her team wanted. That law created a Pervasive Developmental Disorder program offered through the S.C. Department of Disabilities and Special Needs, which essentially provided public funds for autistic children whether they were Medicaid eligible or not.

Nearly 400 families applied for the P.D.D. program this year, and currently 130 children are being served with $3 million appropriated by the Legislature. Now, another 220 children are anticipated to be served with an additional $4.5 million in continuing funds. That would allow about 350 children to receive these vital intervention therapies. Each child is limited to three years in the program, which then would allow new children to be served.

Up to $50,000 coverage
Ryan's Law requires coverage for medium and large companies and state employees. Many small companies, including those that are self-insured, will not receive coverage unless they adapt their plans, Lourie said. Families can get up to $50,000 a year in coverage, and that amount will increase by the rate of inflation.

"The cost of treatment, and whatever minor impact it has on insurance premiums, is significantly lower than the cost of children who weren't treated early or who may be candidates for institutionalization," Lourie said.

So, having a public-private partnership is ideal, advocates say.

"New kids are diagnosed every day," Unumb said. "There have been a couple of dozen children diagnosed since Ryan's Law passed, so the outreach needs to be continuing."

There are 20,000 individuals with autism in the Palmetto State and roughly 377 new cases are diagnosed in children each year, according to Craig Stoxen, president and CEO of the South Carolina Autism Society. His organization has offered family support, information and referral services for 35 years.

ABA therapy has been "the most-proven effective behavioral therapy we know of" for autistic children, Stoxen said. It's been around for about 40 years, and it's most effective for children between ages 3 and 5. Forty-seven percent of kids who get early ABA therapy will be mainstreamed into "regular" classrooms in first grade, Stoxen said.

"The earlier you get it, the better they do," said Verett, who added that Brady could only retain a few words before he began therapy in January. "I don't know where Brady would be without it."

A handful of other states have similar legislation, including Indiana, Wisconsin, Minnesota and Colorado, Stoxen said, and 27 states had bills introduced this year addressing the same issue. The ultimate goal, Stoxen said, is that insurance coverage for autism becomes a federal mandate.

"It really is a financial hardship," Stoxen said, "so a lot of kids who need the service get very limited service. Or even worse, they get nothing at all."

The Verett family was fortunate enough to be among the 130 families now under the P.D.D. program. When it ends for them in three years, they hope insurance will pick up the costs.
Brady's speech and vocabulary have expanded, and he won the "Outstanding Effort Award" in his special education class at Oakland Elementary last year.

"I'm just amazed at what God has done," Verett said. "Brady would not be where he is if we were not in South Carolina."

6 Comments:

Blogger RaeJane said...

Wish this could happen in Illinois.
Our Gov. just budget cut millions for Autism therapies.
It's ridiculous. We certainly cannot afford the therapy our daughter needs.
It's sad that we have to make that kind of choice and if we do, I'm sure there are others, too.

10:10 PM  
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