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In early December, Dr. Anju Usman was the featured speaker at the latest ACE meeting held at Claymore Securities in Lisle. Dr. Usman discussed research presented during the DAN conference held in San Diego, CA in October of 2008 and highlighted developments of interest to families living with autism.
On December 12, 2008 Governor Blagojevich signed SB 934, the Insure Autism Law and it went into effect as Public Act 95-1005 (215 ILCS 356z. 14). ACE Board member Beth Hynes said, "Thanks to Elmhurst dad Pete DiCianni for looking at the discrimination our kids faced and saying ‘no this really shouldn’t be.’ We really needed that gas in the tank. I also want to acknowledge Laura Cellini in Springfield who is a professional lobbyist and has worked tirelessly on passage of the bill."
Under the new law, group, individual health insurance or managed care plans must provide individuals under 21 years of age coverage up to $36,000 per year with no cap on the number of visits to a provider, for the diagnosis and treatment of autism spectrum disorders to the extent that those disorders are not already covered by the policy of accident and health insurance or managed care plan.
At ACE’s December meeting, Hynes highlighted some features of the law that should benefit Illinois families. She noted, "The definition of autism spectrum disorders is pretty broad, including PDD, Aspergers, PDD-NOS and autism. You will need to have a diagnosis. But a physician, a family practitioner or pediatrician can provide one, as can a licensed clinical psychologist." Hynes admitted, "In the past, it hasn’t been to our benefit to let the word out of our mouth, so this is going to be a giant gulp for all of us as we tell the insurance company our child has this diagnosis."
She continued, "There is a very broad definition of the treatments that are classified as ‘medically necessary.’ We wanted to include treatment like HBOT, like IVIG or others not as well-known. You can get a treatment that will prevent the onset of an illness, condition, injury, disease or disability.
It lets us explore some of the outer boundaries of treatments. Now the definition of ‘medically-necessary’ is broad."
Hynes also encouraged families to review the bill’s language and note treatments must be provided by a certified, registered or licensed health professional with expertise in treating the effects of autism spectrum disorder in order to qualify for coverage. She said, "We were trying to get away from the idea that you could only go to a physician. For instance a speech therapist or certified professional in DIR could be covered."
The treatments can be aimed at habilitative and rehabilitative care. Hynes explained, "Insurance companies used to say ‘you can’t prove the child ever had that skill,’ therefore speech and OT were considered habilitative. So we’ve knocked that out with this legislation."
And finally, Hynes reminds families, "The list of therapies included in the bill is not intended to be exhaustive. If Son-Rise therapy is something you believe in, or if there are other types of therapies not specifically mentioned in the bill, we intended for them to be covered with the use of the word ‘including.’ Our goal was to include any ordered therapy provided by licensed or certified individuals that help your child make gains. There are quite a broad range of improvement or progress areas covered by the bill. It could be self-care, feeding, pragmatic skills, receptive and expressive language skills, motor planning, sensory processing or cognitive functioning. It’s broad on purpose to give us the capacity to help our children improve on many fronts."
For more information or links to specific wording, check out these websites.
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