A new state law that mandates insurance coverage for certain autism treatments goes into effect today, and local advocates are hopeful about the possibilities that means for countless children dealing with an autism spectrum disorder.
"What it will mean is that the therapy that has over 50 years of research behind it will now have a paying source for families in Arkansas," said Dayna Miller-Black, founder of Jonesboro-based SPARC of Arkansas, a clinic that offers a variety of therapies, including speech and language, occupational therapy, physical therapy and applied behavior analysis (ABA) therapy.
Many studies have shown that ABA therapy is the most effective treatment for autism and is recognized by the U.S. surgeon general, the American Academy of Pediatrics and the National Institute of Child Health and Development.
But until now many parents have been paying tens of thousands of dollars per year for such ABA therapy because most insurance programs do not cover it.
SPARC-2 Center Inc. in Jonesboro, a nonprofit organization founded by Miller-Black and her business partner, Julie Adkins, has been offering ABA services to children with autism and other neurological disorders at little or no out-of-pocket cost.
"The nonprofit offers all the services not covered under insurance," Miller-Black told The Jonesboro Sun (http://bit.ly/osEnJP).
But limited income for the agency means the number of families in need of the service far exceeds those whom SPARC-2 can serve.
The turning point in Arkansas came last March when Gov. Mike Beebe signed the 2011 Autism Insurance Reform Law. The legislation had been championed by Rep. Uvalde Lindsey, D-Fayetteville, and Sen. Mary Anne Salmon, D-North Little Rock.
The law requires health insurance companies to provide coverage of the screening, diagnosis and treatment of autism spectrum disorders. It has no cap on number of visits.
Insurers will be required to cover ABA treatment, pharmacy care, psychiatric and psychological care, therapeutic care and other treatments determined by a physician.
The law has a $50,000-per-year cap on benefits for ABA coverage, but it allows for children up to 18 to receive those benefits.
Miller-Black said some insurance policies have covered 20 speech therapy sessions a year, which does not adequately serve a child for an entire year. Parents must pay out of pocket or have an additional coverage source to pay for additional sessions, which can range from $85 to $100 an hour.
"It'll help us to be able to serve more kids," Miller-Black said.
She said about 80 percent of SPARC's clients have, or are suspected of having, an autism spectrum disorder. Up to 150 children are served each week.
The law applies only to state-regulated insurance plans and not self-funded plans, which are regulated by the federal government. Most employer-based group insurance plans would be included, while self-funded individual plans are not. Generally it would apply to people employed by the state or insured through their employer.
"So it's not 100 percent great for everybody, but it is a good start," Miller-Black said.
She pointed out that ABA services must be provided by someone who is a Board Certified Behavior Analyst, and there are only about a dozen such people in the state. Most of those work for the Arkansas Board of Education.
That leaves very few professionals to handle the possible influx of clients looking for services once they realize the new law will pay for ABA.
More information about the new law and its impact is available through the Partners for Inclusive Communities at the University of Arkansas for Medical Sciences. Contact Dianna Varady, parent coordinator for the Arkansas Autism Resource & Outreach Center, at 501-682-9900 or 501-526-6084.
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Information from: The Jonesboro Sun, http://www.jonesborosun.com
Source: http://www.sfexaminer.com/news/health/2011/10/new-ark-law-mandates-autism-insurance-coverage
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