Insurance Coverage for Autism Ruth Anan, PhD, BCBA-D Good afternoon. My name is Dr. Ruth Anan and I wish to thank Senator Richardville for arranging these hearings for Senate Bill #359 to amend “The insurance code of 1956” and permitting me to speak today.

Center for Human Development Division of Developmental-Behavioral Pediatrics Meeting Name Meeting Date Meeting Location I am both a licensed psychologist and board certified behavior analyst. For more than a decade I have worked at William Beaumont Hospital in Royal Oak were I am the director of the Early Childhood Program at the Center for Human Development. I am pleased that my testimony today, in favor of this proposed senate bill is fully supported by Beaumont Hospitals.

Comprehensive Autism Assessment My professional responsibilities include conducting diagnostic evaluations as part of a multidisciplinary team. When we conclude that a child has an Autism Spectrum Disorder, I am faced with the difficult task of delivering bad news to parents.

I’m often the bearer of bad news After conducting an interdisciplinary assessment, our team of doctors may confirm that a child has an autism spectrum disorder Sometimes parents already suspect this and their fears are confirmed On other occasions, the diagnosis may come as a surprise and parents are unprepared for this bad news Many times parents already suspect this and I must confirm their fears. On other occasions, this diagnosis comes as an unwelcome surprise and parents are totally unprepared for this bad news.

Parents ask, ‘What would you do?’ Intensive Applied Behavior Analysis (ABA) Ample data demonstrating efficacy Especially when treatment starts early But there is limited availability of this treatment in Michigan Lack of insurance coverage for ABA is more bad news for parents After learning this news, parents often ask me what would I do if my child had autism? Being schooled in the research literature, I tell them I would seek intensive, evidence-based, behavioral intervention as there is ample data demonstrating that this can make a world of difference in children’s live, especially when treatment starts early. But although this message should have been good news, years ago it was not. Instead, I was describing a treatment that was almost nonexistent in Michigan.

HOPE Center In an effort to offer parents some good news, my colleagues and I visited treatment centers in other states, such as the Cleveland Clinic’s Autism Program. Our desire to bring good news to Michigan led to the inception of Beaumont’s HOPE Center in 2002.

Beaumont’s HOPE Center Opened in 2002 GIFT (Group Intensive Family Training) Program Intensive ABA for preschool children Short-term, parent-training model Small group format Allows treatment to be more cost-effective Gives parents sense of empowerment Due to the lack of insurance reimbursement in our state, we developed our GIFT Program, an intensive, but short-term, group parent-training model. Having parents become the agent of change not only makes treatment more affordable, but it also gives parents a sense of empowerment as they see their own efforts produce gains in their children.

GIFT Program I’ll never forget one particular mother who learned the skills to help her son, Andrew, learn to use his words to request things he wanted. This feat was particularly remarkable as this child entered treatment with serious behavior problems (as you’ll see in a short video I’ll show shortly) and he would frequently slam the back of his head against her. Both mother and child were bruised and distraught. Witnessing this child’s progress, and that of many others, is the best news I’ve experienced thus far in my career.

What does this treatment look like? In order to give you a glimpse of what this treatment looks like, I will show a short video of Drew as he and his mother progress through the HOPE Center’s parent-training program.

There has been some good news Our parent-training treatment outcome data were published in a peer-reviewed journal A few insurances now cover GIFT Program Beaumont Employee Health Insurance BCBS of Michigan has a special rider Several out-of-state insurances companies that already cover ABA treatment In order to share the good news we were seeing in our parent-training intervention, we recently published details of our treatment outcomes in a peer-reviewed, scientific journal. Even more good news came when the health insurance offered to Beaumont employees, some forms of Blue Cross Blue Shield, and a few other (usually out-of-state) health insurance companies provide coverage for this model of treatment.

But there is still a lot of bad news Although less expensive, parent-training still remains financially out of reach for many Parent-training places a significant on-going burden on parents as the primary providers of their child’s treatment For many reasons, intensive parent-training is simply not feasible for many families They need professionally-implemented ABA Although our parent-training program costs only a fraction of traditional intensive behavioral therapy, it still remains financially out of reach for many. Moreover, because it places s significant burden on parents as the primary providers of intervention, it is simply not feasible for some families.

Some more good news In 2004 we added another treatment model CARE (Children with Autism Reaching Excellence) Program Delivers high-quality, intensive, professionally- implemented ABA (for up to several years) Preschool children receive individual therapy, but in context of small group setting Therefore, in 2004 we added a program offering intensive, professionally-implemented behavior analytic therapy. Our CARE Program provides one-on-one therapy, in the context of a preschool-like group setting.

CARE Program However, thus far, only a few out-of-state insurance companies have covered this more expensive, but for many children - medically necessary treatment.

Yes, it’s effective, but... It is cost-prohibitive for most families ($60,000/year for full time CARE Program) Almost no insurance in Michigan covers this individual, intensive ABA therapy Most parents “cut corners” by enrolling in CARE Program for only half-days when child’s condition warrants full-day treatment

It won’t be good news until it’s covered by insurance However, without the passage of this Senate bill, very few families can take advantage of this good news.

Michigan’s children need good news! I don’t expect that in my lifetime I will be able to stop giving the bad news of an autism diagnosis to families. But I am hopeful that, someday soon, the bad news will be mitigated by the good news that we have evidence-based intervention available across Michigan and that insurance coverage allows this treatment to be affordable to families in our state.