Insurance to cover autism therapy

By Todd Cohen

RALEIGH, N.C. — For over seven years, advocates for people living with autism worked to persuade state lawmakers to require health insurance plans to cover treatment for autism, an incurable brain disorder that affects 65,000 North Carolinians.

Starting July 1, 2016, as the result of a law enacted this year by the legislature and signed by Gov. Pat McCrory, autism insurance will be available to eligible individuals through age 18. The State Health Plan for state employees already covers autism.

Working like typical health insurance, autism insurance will cover medically necessary treatments such as occupational, speech and physical therapy, as well as psychiatric, psychological and pharmacy care.

Under a key section of the law that autism advocates favored and insurers supported once limits were set on coverage, eligible individuals will get an annual benefit up to $40,000 to cover “adaptive behavioral treatment.”

Advocates say the legislation, already on the books in some form in 42 other states, represents a breakthrough for families in North Carolina living with autism.

Autism typically makes it difficult for an individual to understand verbal or nonverbal signals and cues, or connect in appropriate ways with family members, caregivers, coworkers and others, or to function in settings like a house, office, store or public transportation.

That disconnection can make it a struggle to handle even basic tasks like bathing or eating a meal, or to cope with everyday occurrences at home or work such as a simple disagreement or change in plans.

Behavior therapy has shown success in helping individuals with autism communicate and cope more effectively with the people, places and situations they see and experience every day.

The new law and the insurance coverage it requires will make that behavior therapy available to more North Carolinians, advocates say. Large group insurance plans the law will affect cover 600,000 individuals. Costs will vary by insurer, and co-payments are expected to total $4,000 to $6,000 a year.

“Autism doesn’t differ from other non-curable chronic medical conditions that have been covered traditionally by health insurance,” says Tracey Sheriff, CEO of the Autism Society of North Carolina.

“We’ve got many families in North Carolina paying health insurance premiums, but their children have been excluded from treatments their physicians deem medically necessary,” he says.

Aleck Myers, a psychologist and clinical director at the Autism Society, says therapy helps families living with autism manage the condition and ease its emotional, personal and financial toll.

Autism can be expensive. With traditional treatment, the lifetime cost of managing the condition for just one individual typically can total $3 million to $5 million, Sheriff says.

But intensive one-on-one behavioral therapy, 10 hours to 40 hours a week, particularly for young children, Myers says, can help lower the lifetime cost by as much as $1.6 million.

In May, the Autism Society launched intensive behavior-therapy pilot programs in Raleigh and Charlotte that already serve about 20 individuals, including adults.

“It’s medically necessary to teach adaptive therapy,” Myers says. “This type of therapy is absolutely essential for people with autism.”

Autism Society poised for growth

By Todd Cohen

RALEIGH, N.C. — In their long session that convened January 9, state lawmakers are expected to consider a bill that would require private health insurers to cover treatment related to autism.

That requirement would cover costs that can exceed $50,000 a year for some families and on average would add 31 cents a month to costs for all people insured by companies that offer autism coverage in the 32 other states that have passed similar legislation, says Tracey Sheriff, CEO of the Autism Society of North Carolina.

The legislation, he says, is important in the face of continuing growth in the prevalence of autism, which affects one in 88 individuals in the U.S., including over 60,000 North Carolinians,  up from one in 150 in 2000.

Founded in 1970, the Autism Society provides advocacy, training and education, and direct services for individuals with autism and their families.

The Raleigh-based agency operates with an annual budget of $16 million and a staff of 125 people working full-time, 525 working part-time, and 50 to 75 seasonal employees who work at its Camp Royall in Chatham County.

With five regional offices and five satellite offices throughout the state, the agency in the fiscal year ended June 30, 2012, served nearly 11,000 people with autism, a developmental disability characterized by difficulties in understanding social relationships and interactions.

The Autism Society, for example, employs 18 parent advocates who serve parents of children with autism in all 100 counties in the state, providing support for children throughout their lives.

It also operates 49 chapters, all led by volunteers, that serve families and provide peer support in 66 counties.

And it serves an advocate on public policy issues, including the shift to managed care and the impact it will have on families living with autism.

The agency also provides workshops, conferences and consulting for individuals and families, as well as training for organizations ranging from schools, libraries and churches to medical practices, hospitals, child care providers, and employers. And it operates a bookstore, the largest in the U.S. on autism, that offers 700 titles and last year sold 5,000 items.

It provides residential housing for 25 adults in seven communities, as well as job training, “day programming” for people with autism not ready for competitive employment, and community-based services, mainly for children who live at home.

And its 38-year-old, 133-acre Camp Royall, the oldest and largest camp in the U.S. for people with autism, served 350 adults and children from ages 4 to 64 last summer in 10 one-week sessions, and also serves another 650 people during the rest of the year.

The Autism Society generates $10.3 million in Medicaid reimbursements for its community-based services, housing, and day programs, and $3.3 million through a state contract to help underwrite its advocacy services for individuals and families, its camp, and its training and education services.

It raises another $1.4 million through fundraising, including nearly $150,000 that supports scholarships at Camp Royall.

In December, it raised over $72,000 in its first formal annual fund campaign, double the total it raised a year earlier in its traditional year-end appeal.

It also received a three-year, $100,000 gift from Gregg and Lori Ireland in Chapel Hill through their Ireland Family Foundation to create the position of clinical director, which will be filled by Aleck Myers, the former director of the state’s Murdoch Developmental Center in Butner.

And with founding support from Evernam Family Racing for a Reason, it is launching a program in Davidson that will serve young adults with high-functioning Autism or Asperger’s Syndrome, a mild form of Autism.

While some autism organizations focus on medical research, the Autism Society focuses on supporting people living with the disorder, says Kristy White, the agency’s director of development.

“We are looking to improve the lives of individuals with autism, support families affected by autism, and educate our community,” she says.