From a Dec. 18 article by Disability Scoop:

Autism appears in 1 percent of children and is four to five times more common in boys than girls, a government review of health and educational records indicates, suggesting that the diagnosis is far more common that previously recognized.

The findings, reported in the Center for Disease Control and Prevention’s Morbidity and Mortality Weekly Report, represent a significant increase from the government’s previous prevalence estimate of 1 in 150, though the rise was expected.

Earlier this year, a report conducted jointly by the CDC and the Health Resources and Services Administration found that autism occurred in 1 in 91 children. That report, however, was based on a telephone survey of parents. The new CDC study is considered more reliable because it’s based on 2006 health and educational records of 8-year-olds in 11 communities across the country.

The previous CDC estimate of 1 in 150 was based on an earlier version of the study on 8-year-olds.

The current research finds that communities saw an average increase of 57 percent in the number of children diagnosed with autism between 2002 and 2006.

Further, the research shows autism occuring in 1 in 70 boys and 1 in 315 girls.

It is unclear why the increase in diagnosis is occuring, but some of the rise can be attributed to better awareness of the disorder, researchers say.

The Department of Defense is considering a new rule for its TRICARE health insurance program that would allow non-physicians to make referrals to physical, speech and occupational therapists.

The proposed rule would expand the list of referral sources to physican assistants and certified nurse practitioners.

The Department is accepting comments on the issue through Dec. 28. Click here to read more from the Federal Registry.

A new law effective Jan. 1 requires federal insurance plans to cover habilitative, speech development services by reclassifying speech therapy as medical and not educational.

The new mandate applies only to carriers offering health plans under the Federal Employee Health Benefits Program. HMOs doing business with the federal government were put on notice back in May. The letter reads:  

“All plans must provide speech therapy when medically necessary. If your community package limits speech therapy coverage to rehabilitation only, you must remove that limit for the FEHB Program.”

The mandate won’t apply to plans that insure state employees or non-government workers.

Health plans typically classify developmental speech issues as educational, essentially allowing them to deny speech therapy services. This has been the practice of Florida Medicaid HMOs for at least the past two years.

Children enrolled in Medicaid HMOs such as Amerigroup are often denied speech therapy services because they are ”educational in nature” and “not medically necessary,” according to denial letters sent to families and providers. This is in spite of the fact that speech therapy is clearly covered by Florida Medicaid.

Florida Medicaid HMOs further state that families should obtain therapy services from the school system or enroll children in the state’s Early Steps program, leaving the financially strapped program to pick up the insurance company’s tab.

The new speech therapy mandate for federal employee health benefits is a positive step toward recognizing that these services are medical in nature.

The American Speech-Language Hearing Association was instrumental in this new mandate. To read more about this issue, click here.

The Alliance for Pediatric Therapies now has a Facebook fan page.

Go to www.facebook.com and search for us under Alliance for Pediatric Therapies.

The Los Angeles Times has an excellent article about how healthcare reform legislation could let insurers bypass certain state laws, such as coverage mandates.

The article focuses on bills in the U.S. House and Senate that would allow health insurers to cross state lines, allowing them to skirt consumer protection laws and coverage mandates:  

“Healthcare overhaul bills working their way through Congress could jeopardize laws in California and other states that require insurers to pay for treatments such as AIDS testing, second surgical opinions and reconstructive surgery for breast cancer patients.”

It’s not clear how this language would affect a new Florida law that requires group insurance plans to cover the diagnosis and treatment of autism spectrum disorder. That scenario is not mentioned in the article. But the story does bring into question how states will enforce prompt payment laws. 

 Click here to read the story.

Members of a legislatively appointed study group are drafting a bill that would allow parents to set aside money for services needed by their developmentally disabled children when they grow up. 

The bill, which will be filed for the 2010 legislative session, would essentially set up an investment account for families to tap into when their child “ages” out of the school system and no longer qualifies for services.

The Developmental Disabilities Prepaid Services Study Group is still working on the details of this legislation.

During the 2009 Legislature, Sen. Thad Altman and Rep. Clay Ford filed bills calling for a study into a “prepaid plan” for children with developmental disabilities, similar to the popular Florida Prepaid College Plan.  

The Study Group discussed a provider rate structure, which would allow parents to buy future services at today’s rates. 

At the group’s last meeting, our Alliance Executive Director asked them not to pursue this type of rate structure – particularly if they were based on Medicaid rates, which haven’t increased for therapy providers since 1998.

The study group decided not to proceed with this type of structure. 

While the bill is still under development, it contains language that would allow parents to use the savings plan for “rehabilitation and habilitation services.”

The Alliance for Pediatric Therapies is making advertising opportunities available to businesses and organizations that market to therapy providers.

Medical equipment suppliers, billing agents and software companies are among the many businesses that could benefit from purchasing ad space. Ads would be featured on our website and monthly e-mail blast. Advertising is also available to professional trade associations on the state and national levels.  

For your convenience, we have added a function for credit card payments.

Alliance members will receive a 15% discount on ads.

For rates and ad specifications, click here.

The Florida Office on Disability & Health (FODH) is seeking participants for a survey on issues affecting individuals with disabilities and their health care.

This is your opportunity to speak up specifically for children with disabilities. 

The survey focuses on health conditions of individuals with disabilities and is designed to allow families to respond on their behalf. The information gathered from the survey will help the Office better understand issues affecting individuals and children with disabilities and their health care needs.

To participate in the survey, click here or go to http://fodh.phhp.ufl.edu/

For some background, FODH is housed at the University of Florida’s College of Public Health and Health Professions. The Office was founded in 2007 with funding from the National Centers for Disease Control and Prevention.

In its first year, the Office focused on developing a strategic plan on disabilities and health issues for the state of Florida. The Office developed a list of issues based on input from its board and partners; interviews with stakeholders; and an online survey of Florida residents.

Of those responding to the first survey, 73 percent indicated that funding for health care was by far their foremost concern. Fifty-five percent ranked access to medical care as a top concern. Click here to see the full report.

However, only about 1 percent of the respondents were families with children under the age of 20.

It’s important that their voices be heard too. Please participate in the new survey that is currently underway.

The Agency for Health Care Administration’s goals for next year include finishing the transition to EDS, the state’s new fiscal agent for processing Medicaid payments, according to the agency’s newly released annual report.

The transition from ACS, the former fiscal agent, to EDS has been especially difficult for providers who must wait weeks, even months, to get reimbursed for treating Medicaid recipients.

AHCA, in an annual report released Monday, also hopes to “introduced managed care to previously unserved counties.”

It’s not clear from the report whether this “introduction” will be in the form of Medicaid Reform, a pilot project now limited to five counties (Broward, Duval, Baker, Clay and Nassau).

AHCA Secretary Holly Benson pushed for expansion in the agency’s legislative request for 2009, but lawmakers did not act, saying there was insufficient evidence about the pilot program’s cost savings. Since then, the University of Florida has released a study indicating that the Medicaid reform plans have resulted in costs savings. 

The Legislature is scheduled to decide during the next legislative session whether to expand the pilot program beyond the five current counties.

Meanwhile, 28 other counties have some sort of managed care plans for Medicaid enrollees (access the list here). As of Sept. 1, there were 16 different managed care plans enrolling Medicaid beneficiaries in various counties. Click here to see the list of plans. 

AHCA’s annual report for 2008-09 includes a list of accomplishments and goals for next year. To review the report, click here.

In a departure from previous meetings, the Florida Interagency Coordinating Council for Infants and Toddlers (FICCIT) will not hold discussions with Early Steps providers during its upcoming quarterly meeting.

FICCIT members are scheduled to meet next Tuesday, Sept. 22, and Wednesday, Sept. 23, in Orlando (Homewood Suites, 8745 International Drive).

FICCIT is a federally mandated group appointed by the governor to ”assist public and private agencies in implementing a statewide system of coordinated, comprehensive, multidisciplinary, interagency programs providing appropriate early intervention services to infants and toddlers with disabilities and risk conditions and their families,” according to its website. In Florida, that statewide system is the Early Steps program.

Members of FICCIT include parents and officials from Early Steps, the Office of Insurance Regulation, Department of Health and other various state agencies (click here to see the list of people appointed by the governor). 

The group’s responsibilities include providing policy development recommendations and getting feedback from families and providers, according to the FICCIT website.  

Typically, FICCIT members meet separately with Early Steps providers to get feedback about how the program is working. In a provider meeting last year in Orlando, it came to light that the regional Early Steps program in that area was reimbursing providers far less than other regions for various services. As a result, the Orlando area Early Steps program is now paying providers the full amount for those services.

These provider meetings have also brought to light problems with provider enrollment and other issues, such as the need for more accountability for Infant Toddler Developmental Specialists (see minutes here). The Alliance looks forward to working with regional and state-level Early Steps officials to resolve these issues.