Tuesday, December 29, 2009

OPPORTUNITY: 2010 Joseph P. Kennedy, Jr. Foundation Public Policy Fellowships

The Joseph P. Kennedy, Jr. Foundation Public Policy Fellowship Program 2010-2011
The Joseph P. Kennedy, Jr. Foundation is seeking exemplary professionals and/or family members of persons with intellectual or developmental disabilities who are currently working or volunteering in the field of inclusive services and supports for people with intellectual and developmental disabilities for an intensive one-year Public Policy Fellowship in Washington, D.C. The purpose of the Fellowship is to prepare both early career and veteran leaders to assume leadership in the public policy arena in their home state and/or nationally. During this one year Fellowship, the successful applicant will learn how federal legislation is initiated, developed, and passed by the Congress, as well as how programs are administered and regulations promulgated by federal agencies.
The application deadline for 2010-2011 is March 5, 2010 by 5:00 P.M. EST
The Fellowship starting date will be negotiated with the successful applicant. The Foundation anticipates up to three fellowships will be awarded for the period July, 2010-June 30, 2011

FULL INFORMATION on application for the Public Policy Fellowship program

The Joseph P. Kennedy Jr. Foundation
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Views and news expressed in this blog or by the PIBA SIG are those of the SIG or SIG members and do not represent official policy of ABA International or other official body. For official policy of the Association of Behavior Analysis International, the reader is directed to their website, http://www.abainternational.org

Saturday, December 26, 2009

ABAI NEWSFLASH: Expansion of the Practice Board and Board Member Activities

Expansion of the Practice Board and Board Member Activities

The Association for Behavior Analysis International (ABAI) Practice Board has been very active over the past six months. Membership and the focus of the Board has been expanded; this was done to address issues ABAI members have identified as critical to their support needs in the practice of applied behavior analysis...

Included in this expansion of the Practice Board membership are the following,
 

Chair: Michael  F. Dorsey, Ph.D., BCBA

Committees  and respective committee chairs:

Members of the ABAI Practice Board have attended or are scheduled to attend a number of ABAI affiliated state chapter and related conferences this year, including:
Practice Board members are available to present at state conferences on subjects related to practice or to consult with chapters on issues such as the development of state licensing laws or third party insurance billing. Recently, Thomas Zane, Michael Weinberg, and Michael Dorsey were invited to meet with the Board of Directors of New Jersey ABA and consult on the potential development of a state licensing law.

Please feel free to contact the ABAI office to request an appearance or meeting with Practice Board members.

Billing Committee Update

Travis Thompson, Ph.D., Co-Chair of the ABAI Practice Board’s Insurance Billing Committee reported on December 22, 2009 that his committee recently forwarded a "Letter of Intent" to submit a Current Procedural Terminology (CPT) Billing Code proposal covering ABA services for children diagnosed with Autism to the American Medical Association for consideration. Dr. Thompson noted that a representative from AMA contacted him today and that they confirmed receiving our letter of intent. Further, the AMA representative commented that the AMA thought the committee appropriately involved a cross-section of constituencies and organizations, and they noted that it was a good step that the Chair of the Section on Developmental and Behavioral Pediatrics (which oversees ADHD and autism) of the American Academy of Pediatrics (AAP) has offered to assist with the effort. AAP is the major professional organization for all pediatricians. Dr. Thompson noted that the ABAI proposal is anticipated to be submitted to the AMA Committee June 2010. The AMA representative noted that, if our request is acted on favorably at the June 2010 meeting, the new codes could be in place by June 2012.
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Related links and posts:

Practice Resources, ABA International

Sunday, December 20, 2009
Practitioner Issues in Behavior Analysis SIG Blog
December 2009 notes on recent activities of the ABAI Practice Board

Wednesday, May 27, 2009
Practitioner Issues in Behavior Analysis SIG Blog 
ABAI NEWSFLASH: New Practice Resources at ABA International!

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Views and news expressed in this blog or by the PIBA SIG are those of the SIG or SIG members and do not represent official policy of ABA International or other official body. For official policy of the Association of Behavior Analysis International, the reader is directed to their website, http://www.abainternational.org

Thursday, December 24, 2009

NEWS: U.S. Senate passes HR3590: Patient Protection and Affordable Care Act

HR 3590: Patient Protection and Affordable Care Act passed in the U.S. Senate early December 24, 2009 with a 60-39 vote split along party lines.





The bill will now go to a House-Senate conference committee to reconcile HR 3590 and the House-passed bill, HR 3962: Affordable Health Care for America Act, the bill passed in the U.S. House on November 7, 2009. It is anticipated that informal discussions will commence during the holidays prior to the reconvening of the House on January 12, and the Senate on January 19, with an eye to reaching a compromise that can pass both houses of the U.S. Congress and be favorable to President Barack Obama's signature prior to the annual State of the Union address.

For further reading and past blogposts:

Senate approves health care reform bill
CNN
By Alan Silverleib, CNN
December 24, 2009 1:01 p.m. EST

Senate Says Yes To Landmark Health Bill
National Public Radio
by Scott Hensley
December 24, 2009

Next Step: Getting A Health Bill To Obama's Desk
National Public Radio
by Kevin Whitelaw
December 24, 2009

Newsmaker: Obama on Health Reform Politics, Copenhagen Climate Outcome
NEWSMAKER INTERVIEW    AIR DATE: Dec. 23, 2009
PBS Newshour
also mp3 and transcript

Monday, December 21, 2009
Practitioner Issues in Behavior Analysis SIG Blog
NEWS: U.S. Senate health care bill HR 3590 passes crucial hurdle; passage in Senate expected by December 25

Tuesday, December 15, 2009
Practitioner Issues in Behavior Analysis SIG Blog
NEWS: CLASS Act stays in health care reform, and estimate of the Congressional health care reform legislative calendar

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Views and news expressed in this blog or by the PIBA SIG are those of the SIG or SIG members and do not represent official policy of ABA International or other official body. For official policy of the Association of Behavior Analysis International, the reader is directed to their website, http://www.abainternational.org

Tuesday, December 22, 2009

FYI: Self-funded Health Insurance Plans and ERISA

With the state legislature sessions opening soon and the likelihood of insurance reform legislation submissions, it seems timely to point out information on reimbursement (and limitations) under self-funded health insurance Plans, and to make note either as an advocate or potential beneficiary of legislation as to the language of a bill (or law) in regards to the matter of self-funded policies.

As noted by Autismvotes, in its webpage, Information for Families With Self-Funded Health Insurance Plans
"Even in the states that have passed autism insurance reform , many children are still unable to receive treatment because they are insured through self-funded plans that are not regulated by the state.  If you work for a large company or government, there is a chance your health plan is a self-funded insurance plan.  For self-funded insurance plans, federal ERISA [Employee Retirement Income Security Act of 1974 (ERISA)] law preempts most state insurance regulations, including benefit reforms like autism insurance reform..."
Some of the useful resources at Autismvotes are,
  • Self-funded plans: Establishing an autism benefit
  • How Private Health Insurance Works: A Primer
  • Companies with self-insured health plans that have opted to provide coverage for autism therapies
The Association of Professional Behavior Analysts (APBA) also recently published an article on self-insured entities, with pointers on which self-insured companies provide ABA coverage in their policies,
Self-Insured Employers Cover ABA Intervention for Autism and Other Special Needs
Laurie Stuebing, APBA Autism Task Force
APBA Reporter Issue # 3
- February, 2009.

One other useful reference is from the State of Colorado, Division of Insurance - this has some Colorado-specific clauses, but in general is a clear, lay-friendly explanation of ERISA, self-funded plans, and information on departments in the Federal Government dealing with this area.

ERISA -- Employer-sponsored Self-funded Health Benefit Plans
Colorado Division of Insurance January 2009
  • What is ERISA?
  • What is the difference between a health insurance plan and an employer-funded health benefit plan
  • (ERISA)?
  • What steps can I take if I am covered under an ERISA plan and my claim is denied?
  • Who has regulatory authority for ERISA plans?
  • What are required procedures for Employee Welfare Benefit Plans (Self-funded Plans)?
  • What is the “summary plan description” and how does it work?
  • Do states have the authority to regulate Employer-sponsored Self-funded Health Benefit Plans?
  • How many people in Colorado are insured under an employer-sponsored or self-funded health benefit plan (ERISA plan)?
  • Who can provide more information on Employer-Funded Health Benefit Plans?
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Views and news expressed in this blog or by the PIBA SIG are those of the SIG or SIG members and do not represent official policy of ABA International or other official body. For official policy of the Association of Behavior Analysis International, the reader is directed to their website, http://www.abainternational.org

Monday, December 21, 2009

NEWS: U.S. Senate health care bill HR 3590 passes crucial hurdle; passage in Senate expected by December 25

The Los Angeles Times reports  that a cloture motion was passed in the U.S. Senate Monday morning at 1 AM EST, allowing HR3590: Patient Protection and Affordable Care Act  to proceed towards expected approval in that chamber this week. The Senate is in recess until 12:00 PM EST Monday/today.

It is also reported that, dependent on HR 3590 passing in the Senate, a conference committee will convene early in 2010 to reconcile the differences between the House [HR 3962]  and Senate [HR 3590]  versions of health care reform legislation.

Politico blog reports that votes on HR 3950 are scheduled for 1 a.m. Monday 12/21 (time past) The second is to be 1 p.m. Wednesday 12/23, and the final one will be at 7 p.m. Thursday 12/24/09, although given the moment by moment developments in health care reform deliberation, these may be subject to change.

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For further reading & Past Blog Posts
Health Bill May Pass Senate By Christmas
NPR Morning Edition
Audio Will be available at 9:00am ET

Senate Democrats get 60 votes to move healthcare bill along
By Janet Hook and Noam N. Levey
December 21, 2009
Los Angeles Times

GOP leader vows to stay to February
By MIKE ALLEN | 12/21/09 3:52 AM EST
Politico

Senate votes to give green light to health care bill
December 21, 2009 4:18 a.m. EST
CNN

Tuesday, December 15, 2009
NEWS: CLASS Act stays in health care reform, and estimate of the Congressional health care reform legislative calendar

Tuesday, December 1, 2009
ACTION OPPORTUNITY: Online petition requests behavior analysis be included in health care reform


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Views and news expressed in this blog or by the PIBA SIG are those of the SIG or SIG members and do not represent official policy of ABA International or other official body.
For official policy of the Association of Behavior Analysis International, the reader is directed to their website, http://www.abainternational.org

Sunday, December 20, 2009

December 2009 notes on recent activities of the ABAI Practice Board

[Note -  This is a reminder that while a Special Interest Group of ABA International, statements of the Practitioner's Issues in Behavior Analysis SIG (PIBA-SIG) do not represent, nor claim to represent,  formal policy of the Association for Behavior Analysis, International (ABAI). The below notice is just a summing up/an FYI of that information currently available publicly on the ABA International website, and readers are encouraged to go to the primary sources for full and definitive information]
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The ABA International newsletter, Inside Behavior Analysis 1(2), December 2009 reported some interesting and useful updates on developments within ABA International by the ABAI Practice Board.
Inside Behavior Analysis states that this is a followup to an earlier email communication sent to members in September.

Below is a summary of what was reported in the newsletter on Practice Board activities and focus at the current time. Please refer to Inside Behavior Analysis 1(2), December 2009 for the full article, and consult the Practice Board pages at ABA International.

Insurance coverage
Licensure
  • Descriptions are given of state licensure acts that have already passed and initiatives in progress or proposed, as well as progress on a model licensing act
Governmental affairs
  • Members of the Practice Board have been meeting with some of the affiliated chapters to assist with governmental advocacy, and will be expanding in the future to international efforts.
  • Information is given on members of the Practice Board to contact should an affiliated chapter or organization be considering bills that would affect practitioners of behavior analysis
Affiliated Chapter support
A New Practitioner Hotline
  • A practitioner hotline has been created to give access to consultation services and advice to behavior analysis practitioners on pressing professional issues.
Agency Management
  • A committee is forming for those behavior analysts who have positions of responsibility in the private or public sector as CEO/COO of large agencies, Special Education Director or in service to school boards or state committees. The purpose of this committee is provide a forum for ABAI members in such roles and to provide a mentor service for new to such positions. 
  • There is currently an invitation offered for those who would be interested in participation on such a committee
Task Forces
  • Position Statements
    • A task force with joint participation of the Science and Practice Boards has been formed on the question of seclusion and restraint. The charge of the task force is to develop and recommend a position statement on the appropriate use of restraint and seclusion to be submitted to ABAI Full Members for consideration.
  • Code of Ethics
    • A task force is currently being assembled to study the implications of revising a code of ethics for behavior analysts that will represent and support scientists and researchers, educators, and practitioners.
Higher Education Accreditation and improvements
  • Various initiatives are in progress, headed by the ABAI Education Board, to develop or improve criteria related to higher education standards in the training of behavior analysts.
For other updates, also see the below pages of which may contain additional details or elaborations of the above summaries, and additional information, such as contact people and Board Members within ABA International,

A Letter From the ABAI President
By Raymond G. Miltenberger, Inside Behavior Analysis 1(2), December 2009

Practice Board Page at ABA International,

Practice Resources page at ABA International
Which has news you can use in aid of advocacy on a variety of issues, and the formal Position Statements of ABA International

ABAI Education Board
By Charles T. Merbitz, Inside Behavior Analysis 1(2), December 2009
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Views and news expressed in this blog or by the PIBA SIG are those of the SIG or SIG members and do not represent official policy of ABA International or other official body. For official policy of the Association of Behavior Analysis International, the reader is directed to their website, http://www.abainternational.org
 

Friday, December 18, 2009

NEWS: December 18 CDC Report finds increased autism prevalence from 2002 to 2006


**Update 7:30PM PST to add popular press articles on the story**
CDC Finds About 1 Percent Of Kids Have Autism
By Jon Hamilton, National Public Radio (NPR)
December 18, 2009 4:04 p.m. EST


Study: 1 in 110 U.S. children had autism in 2006
By Miriam Falco, CNN Medical News
December 18, 2009 4:39 p.m. EST

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A significant report from the December 18, 2009 Mortality and Morbidity Weekly Report volume 58, No. SS-10, prepared by the U.S. Centers for Disease Control and Prevention (CDC), reports that data from the Autism and Developmental Disabilities Monitoring (ADDM) Network shows an increased prevalence of ASD diagnosis in the 8-year olds sampled in 2006 compared to the previous survey of 2002 which was reported in the MMWR of February 9, 2007.

Article:
Prevalence of Autism Spectrum Disorders-Autism and Developmental Disabilities Monitoring Network, United States, 2006. Morbidity and Mortality Weekly Report; December 18, 2009; 58 (SS-10). CDC. [pdf version]

Abstract
Problem/Condition:
Autism spectrum disorders (ASDs) are a group of developmental disabilities characterized by atypical development in socialization, communication, and behavior. ASDs typically are apparent before age 3 years, with associated impairments affecting multiple areas of a person’s life. Because no biologic marker exists for ASDs, identification is made by professionals who evaluate a child’s developmental progress to identify the presence of developmental disorders.Reporting Period: 2006.

Methods:
Earlier surveillance efforts indicated that age 8 years is a reasonable index age at which to monitor peak prevalence. The identified prevalence of ASDs in U.S. children aged 8 years was estimated through a systematic retrospective review of evaluation records in multiple sites participating in the Autism and Developmental Disabilities Monitoring (ADDM) Network.

Data were collected from existing records in 11 ADDM Network sites (areas of Alabama, Arizona, Colorado, Florida, Georgia, Maryland, Missouri, North Carolina, Pennsylvania, South Carolina, and Wisconsin) for 2006. To analyze changes in identified ASD prevalence, CDC compared the 2006 data with data collected from 10 sites (all sites noted above except Florida) in 2002. Children aged 8 years with a notation of an ASD or descriptions consistent with an ASD were identified through screening and abstraction of existing health and education records containing professional assessments of the child’s developmental progress at health-care or education facilities. Children aged 8 years whose parent(s) or legal guardian(s) resided in the respective areas in 2006 met the case definition for an ASD if their records documented behaviors consistent with the Diagnostic and Statistical Manual of Mental Disorders, 4th edition, text revision (DSM-IV-TR) criteria for autistic disorder, pervasive developmental disorder–not otherwise specified (PDD NOS), or Asperger disorder. Presence of an identified ASD was determined through a review of data abstracted from developmental evaluation records by trained clinician reviewers.

Results:
For the 2006 surveillance year, 2,757 (0.9%) of 307,790 children aged 8 years residing in the 11 ADDM sites were identified as having an ASD, indicating an overall average prevalence of 9.0 per 1,000 population (95% confidence interval [CI] = 8.6–9.3). ASD prevalence per 1,000 children aged 8 years ranged from 4.2 in Florida to 12.1 in Arizona and Missouri, with prevalence for the majority of sites ranging between 7.6 and 10.4. For 2006, ASD prevalence was significantly lower in Florida (p<0.001) and Alabama (p<0.05) and higher in Arizona and Missouri (p<0.05) than in all other sites. The ratio of males to females ranged from 3.2:1 in Alabama to 7.6:1 in Florida. ASD prevalence varied by type of ascertainment source, with higher average prevalence in sites with access to health and education records (10.0) compared with sites with health records only (7.5). Although parental or professional concerns regarding development before age 36 months were noted in the evaluation records of the majority of children who were identified as having an ASD, the median age of earliest documented ASD diagnosis was much later (range: 41 months [Florida]–60 months [Colorado]). Of 10 sites that collected data for both the 2002 and 2006 surveillance years, nine observed an increase in ASD prevalence (range: 27%–95% increase; p<0.01), with increases among males in all sites and among females in four of 11 sites, and variation among other subgroups.

Interpretation:
In 2006, on average, approximately 1% or one child in every 110 in the 11 ADDM sites was classified as having an ASD (approximate range: 1:80–1:240 children [males: 1:70; females: 1:315]). The average prevalence of ASDs identified among children aged 8 years increased 57% in 10 sites from the 2002 to the 2006 ADDM surveillance year. Although improved ascertainment accounts for some of the prevalence increases documented in the ADDM sites, a true increase in the risk for children to develop ASD symptoms cannot be ruled out. On average, although delays in identification persisted, ASDs were being diagnosed by community professionals at earlier ages in 2006 than in 2002.

Public Health Actions:
These results indicate an increased prevalence of identified ASDs among U.S. children aged 8 years and underscore the need to regard ASDs as an urgent public health concern. Continued monitoring is needed to document and understand changes over time, including the multiple ascertainment and potential risk factors likely to be contributing. Research is needed to ascertain the factors that put certain persons at risk, and concerted efforts are essential to provide support for persons with ASDs, their families, and communities to improve long-term outcome.

Some interesting excerpts from the December 18, 2009 MMRW article,

page 7: 
"...In general, estimated ASD prevalence was lower in ADDM sites that relied solely on health sources to identify cases (mean: 7.5 per 1,000 population; CI = 7.0–7.9) compared with sites that also had access to education sources (mean: 10.2 per 1,000 population; CI = 9.7–10.7) (p<0.001). For sites that relied solely on health sources, identified ASD prevalence was significantly higher in Missouri (12.1) and significantly lower in Florida (4.2) (p<0.001). Among sites with access to education sources, identified ASD prevalence was significantly higher in Arizona (12.1) than in each of the other sites (p<0.05) whereas prevalence in Colorado (7.5) was significantly lower (p<0.05) than in Arizona (12.1), Georgia (10.2), and North Carolina (10.4). In sites with access to both health and education sources, the proportion of ASD cases identified exclusively from education sources ranged from 20% in North Carolina to 78% in Arizona..."
From Discussion, page 14: 
"...Children identified with an ASD in 2006 reflect a group with less co-occurring cognitive impairment than the population identified ≥20 years ago, when autism was conceptualized in a more severe and singular form compared with the spectrum of disorders identified today (2,34). In 2006, of all children with an ASD for whom testing documentation was available, 41% had cognitive impairment. When modern criteria are applied, children identified are less likely to test as having general cognitive impairments, and unusual learning profiles indicating scatter in cognitive skills rather than across-the-board cognitive delays might be more salient indicators of an ASD than intellectual impairment (35)..."
Under Limitations, page 17:
"...In addition, CDC is conducting a validation study comparing records-based to direct evaluation methods. Although the ADDM sites were not selected to be a nationally representative sample, the population included represents a substantial number of children, >300,000 (7.9%) of all children in the United States aged 8 years in 2006..."

Under Public Health Implications, page 18: 
"Whether identified ASD prevalence estimates will plateau or continue to increase is unknown. The ADDM cohorts in this report comprise children born in 1994 (for 2002 data) and 1998 (for 2006 data). Children born starting in the mid-to-late 1990s were particularly susceptible to the changing influence of the new DSM-IV criteria in 1994 and to increased autism awareness among the public and health professionals (2,3). The impact on estimated ASD prevalence of the broadening of diagnostic criteria and the increased awareness of ASDs might reach a high point and then diminish after a period of time. Therefore, evaluating the prevalence of ASDs among children born in this millennium using the same standard for evaluating the change in ASD symptoms over time is critical to understanding the current and changing population of children with ASDs. Of note, recent research indicates that the core social traits of autism are distributed in the population along a continuum (51); where the line is drawn between trait measures regarded as normal variance in behavior versus those labeled as impairment or disability might affect ASD prevalence estimates. The landscape of ASD diagnoses is likely to change with the introduction of the next version of the DSM expected in 2012. Efforts are needed to examine prevalence changes in other childhood conditions such as attention-deficit/hyperactivity disorder, asthma, and allergies to assess whether changes in ASD prevalence are occurring in isolation (52–54)...."
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For further information, references:

CDC Press Briefing on Autism Surveillance Summary
Rough unedited transcript and mp3
Friday December 18, 2009.

The current report:

The prior reports from 2007

The Autism and Developmental Disabilities Monitoring (ADDM) Network
Autism and Developmental Disabilities Monitoring (ADDM) Network Publications

Morbidity and Mortality Weekly Report (MMWR)

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Views and news expressed in this blog or by the PIBA SIG are those of the SIG or SIG members and do not represent official policy of ABA International or other official body. For official policy of the Association of Behavior Analysis International, the reader is directed to their website, http://www.abainternational.org

NEWS: From the December Organization for Autism Research (OAR) Newsletter

About OAR,
"The Organization for Autism Research (OAR) was created in December 2001–the product of the shared vision and unique life experiences of OAR’s seven founders. Led by these parents and grandparents of children and adults on the autism spectrum, OAR set out to use applied science to answer questions that parents, families, individuals with autism, teachers and caregivers confront daily. No other autism organization has this singular focus."
"OAR’s Scientific Council is comprised of 14 leading autism and medical professionals [including Behavior Analysts] serving as an expert information resource for all OAR matters concerning issues of research.  In that regard, the Council assists OAR’s Board of Directors in developing its research strategy, near term priorities, and long-range research objectives.  The Council also provides program guidance and oversight for OAR´s research competition and plays a central role in ensuring the highest quality reviews for prospective OAR research proposals."

Some headlines from this month's December 2009 OARacle

More than 1,000 People Meet to Advance the Future of Adults with Autism

"On November 13, 2009, the Advancing Futures for Adults with Autism (AFAA) National Town Hall was held with the support and participation of OAR. For this, the first such meeting of its kind, more than 1,000 family members, professionals, adults on the spectrum, and community members gathered simultaneously, via live webcast, at 15 satellite locations across the country, as well as through an online virtual site...While many priorities were uncovered through the process, several rose to the top:
  • In cross-cutting strategies, many felt it was essential to change funding streams so that financial assistance follows the person. In addition, accessibility to necessary supports should be ensured, and the availability of qualified and motivated personnel should be increased.
  • Two housing strategies that met with overall approval were to support person-centered service models and expand both public and private funding for residential services.
  • Regarding employment of individuals, attendees throughout the country felt the need for support, both during school years in the form of vocational skills training and through adulthood in the form of employment supports.
  • When discussing community-life strategies, nearly all agreed that one priority is essential--the need for first responders to be educated about the behaviors that might arise when encountering individuals with autism in emergency/first-response situations.
A preliminary report, distributed to attendees that day, summarized the day’s activities, including conclusions drawn and demographic information..."
FULL STORY


OAR President Presents to Autism Speaks’ Scientific Advisory Committee
"...On November 5, OAR President Peter Gerhardt, Ed.D., along with Marsha Mailick Seltzer, Ph.D., met with the Autism Speaks Scientific Advisory Committee (SAC) to discuss the needs of adolescents and adults with autism at the SAC’s annual meeting held on the campus of the University of North Carolina...Dr. Gerhardt spoke about some of the factors that may impact effective transition in practice. Stressing that the poor outcome data are more a function of a significant systems failure than an actual failure of people with autism, Dr. Gerhardt noted that if transition planning is to be effective (at any age), it must incorporate intensive community–based instruction, direct attention to skills subsumed under the heading of adaptive behavior, and result in a significant degree of inclusion in the community where the person with autism lives..."
FULL STORY

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Views and news expressed in this blog or by the PIBA SIG are those of the SIG or SIG members and do not represent official policy of ABA International or other official body. For official policy of the Association of Behavior Analysis International, the reader is directed to their website, http://www.abainternational.org

LEG. NEWS: New Hampshire autism insurance bill on the calendar for 2010

In November, 2009 The Concord Monitor reported on an autism insurance bill containing behavior analysis coverage, 
A push to cover autism therapy
KAREN LANGLEY
Monitor staff
November 13, 2009

The story reports that the bill, N.H. HB 569-FN: requiring insurance coverage for diagnosis and treatment of autism spectrum disorders, passed out of the House Commerce and Consumer Affairs Committee on November 12,2009 and is expected to come to the New Hampshire House floor in 2010.

Some notable quotes from the story, made by Representatives from the House Committee,

Rep. Susi Nord, who led a subcommittee's research, saw the economic saving to New Hampshire as an attractive factor that eased passage in the Committee,
"...Access to appropriate treatments helps nearly half of autistic children develop typical social behaviors and an additional 40 percent make significant progress, according to a study by the national Autism Society. When the costs of those treatments are combined with the lifetime costs of services for the child, access to treatments saves $1.9 million per child. For children identified in New Hampshire, that's $597.8 million society won't pay, Nord told committee members yesterday.

'Rather than cutting out things that people actually need, we're cutting out needs that will be on the state," she said. "We should be making situations so people won't be depending on the state in the future'...."
 Another Representative, Rip Holden, agreed and saw the bill as a win-win.
"If these kids become productive citizens, not only have we helped them morally, but we've helped ourselves as a society," he said. "Not to sound crass, but they become taxpayers." 

The information from the New Hampshire General Court website on HB 569-FN is, that having come out of Committee, that the bill is anticipated to come to the House Floor on Wednesday, January 6, 2010 when the New Hampshire House reconvenes.

State of New Hampshire
HOUSE RECORD
Second Year of the 161st General Court

The Calendar and Journal of the 2010 Session
Vol. 32 , Concord, N.H. Thursday, December 10, 2009, No. 2
Contains:  Reports for January 6, Legislative Ethics Committee Interpretive Ruling, Hearings, Meetings and Notices


For HB 569-FN, the Majority report is (scan down the Calendar to find the reference),
"Rep. Susi Nord for the Majority of  Commerce and Consumer Affairs: This bill is a clarification of our existing mental health parity statute with regard to insurance coverage for children with autism.  The current statute includes autism as a covered condition; however medical bills for important aspects of the therapy are still not being paid by insurance companies.  The committee retained this bill and requested that the insurance department conduct a review of the status of coverage for treatment and found that certain types of treatment are being denied as “habilitative” (promoting a new behavior rather than repairing an already existing behavior).  The majority of the committee concluded, instead, that such treatments and therapies are in fact often necessary and vital aspects of treatment.  The amendment does not change the scope of the current statute or the ability of insurance companies to determine medical necessity nor does it shift the responsibility for the educational aspects of the therapy from the schools to the insurance companies or give children with autism greater coverage than those with other conditions.  The amendment states that behavioral therapy, speech and occupational therapy are to be covered along with the already-covered medications, health related services and psychiatric services when they are part of a written plan ordered by a doctor who is prescribing these therapies using a nationally recognized standard of care such as the standard of the American Academy of Pediatrics.  Requiring a written plan actually creates a higher level of scrutiny for coverage than currently exists.  There will be a minimal cost increase to the insurance industry (less than ½ of 1%) however the cost savings to the state and the local school districts over the life of the children who receive proper treatment averages just over $1.9 million per child.  This bill will ensure that children will receive proper care for their condition and will, as a result, use dramatically less assistance from the state.  For the entire covered population this translates to a savings of about $597 million to our school districts and DHHS.  At a time when we as legislators are under pressure to reduce costs in these areas, this bill is one way to do exactly that. [Committee vote] Vote 13-3."
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Views and news expressed in this blog or by the PIBA SIG are those of the SIG or SIG members and do not represent official policy of ABA International or other official body. For official policy of the Association of Behavior Analysis International, the reader is directed to their website, http://www.abainternational.org

Thursday, December 17, 2009

S. 2860 bill on restraint and seclusion joins HR 4247 & Wrightslaw sums up this legislation

Wrightslaw has put together an info page on the recently submitted Federal bills on restraint and seclusion in schools,
H.R.4247 (Miller, McMorris Rodgers + 7 co-sponsors)  and now S. 2860 (Dodd).

Preventing Harmful Restraint and Seclusion in Schools Act (H.R. 4247)
  • Preventing Harmful Restraint and Seclusion in Schools Act: What Does it Mean for Children with Disabilities?
  • IEPs, BIPs, and Educational Plans
  • National Reports on Restraint and Seclusion 
 The text of this legislation is now available at Thomas.gov, and both bills have been assigned to Committees

House bill,
H.R.4247 : To prevent and reduce the use of physical restraint and seclusion in schools, and for other purposes.
Sponsor: Rep Miller, George [CA-7] (introduced 12/9/2009)      Cosponsors (7)
Committees: House Education and Labor
Latest Major Action: 12/9/2009 Referred to House committee. Status: Referred to the House Committee on Education and Labor.

Senate bill,
S.2860 : A bill to protect students from inappropriate seclusion and physical restraint, and for other purposes.
Sponsor: Sen Dodd, Christopher J. [CT] (introduced 12/9/2009)      Cosponsors (None)
Committees: Senate Health, Education, Labor, and Pensions
Latest Major Action: 12/9/2009 Referred to Senate committee. Status: Read twice and referred to the Committee on Health, Education, Labor, and Pensions.

There is a great deal of public support and attention by advocates to this legislation, which has received widespread visibility due to issued reports and the Congressional public hearing of the past year. It is anticipated that both bills will be given attention early in 2010.

Previous blogposts

Wednesday, December 9, 2009
NEWS: H.R. 4247 - The Preventing Harmful Restraint and Seclusion in Schools Act

Tuesday, December 8, 2009
NEWS: December 9 Introduction of Federal Bill on School Restraint and Seclusion

Tuesday, June 2, 2009
NEWS: Comments by Education Secretary Arne Duncan on the use of restraint & seclusion in public schools 

Tuesday, May 19, 2009
NEWSFLASH: GAO Report and House Committee hearing on Seclusion and Restraint in Public and Private Schools 

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Views and news expressed in this blog or by the PIBA SIG are those of the SIG or SIG members and do not represent official policy of ABA International or other official body. For official policy of the Association of Behavior Analysis International, the reader is directed to their website, http://www.abainternational.org

Wednesday, December 16, 2009

ACTION: White House Office of Science & Technology Asks For Public Input On Improving Public Access to Results of Federally Funded Research

The U.S. Office of Science and Technology (OSTP) is the Federal Department that advises the U.S.President and those in the Federal Executive on the effects of science and technology on domestic and international affairs.

The mission of OSTP as defined by Public Law 94-282 is to
"Serve as a source of scientific and technological analysis and judgment for the President with respect to major policies, plans, and programs of the Federal Government.
P.L. 94-282 authorizes OSTP to:
  • Advise the President and others within the Executive Office of the President on the impacts of science and technology on domestic and international affairs;
  • Lead an interagency effort to develop and implement sound science and technology policies and budgets;Work with the private sector to ensure Federal investments in science and technology contribute to economic prosperity, environmental quality, and national security;
  • Build strong partnerships among Federal, State, and local governments, other countries, and the scientific community;
  • Evaluate the scale, quality, and effectiveness of the Federal effort in science and technology.
On December 9, 2009, OSEP, in partnership with the White House Open Government Initiative issued  an announcement on the OSEP blog requesting public input via an online "Public Access Policy Forum" on Federal science policy having to do with public access to federally-funded research results.

The three major areas of interest in the Forum, and the dates when discussion and input on each topic are solicited are,
  1. Implementation (Dec. 10-20, 2009)
  2. Features and Technology (Dec. 21-31, 2009)
  3. Management (Jan.1-7, 2010)
At this time, area 1: Implementation, is the topic under discussion.

For full information, see the posts at the OSTP Blog,

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Views and news expressed in this blog or by the PIBA SIG are those of the SIG or SIG members and do not represent official policy of ABA International or other official body. For official policy of the Association of Behavior Analysis International, the reader is directed to their website, http://www.abainternational.org

Tuesday, December 15, 2009

NEWS: CLASS Act stays in health care reform, and estimate of the Congressional health care reform legislative calendar

Easter Seals sent out a notice today announcing that the Community Living Assistance Services and Supports (CLASS) Act has been retained in the current U.S. Senate health reform bill [HR3590: Patient Protection and Affordable Care Act] ,

and gave an estimate of where the health reform calendar might be going in the next month or so,
"Looking Ahead to 2010

The Senate will continue to debate various details of its health care legislation through the next two weeks. After a final vote, a House and Senate committee will then work out any differences between their bills

House:
HR3962: Affordable Health Care for America Act
Senate:
HR3590: Patient Protection and Affordable Care Act

and the committee bill will return for floor votes in both chambers.

A final agreement could be sent to the President as early as January 2010."
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Website: Practitioner Issues in Behavior Analysis SIG
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Views and news expressed in this blog or by the PIBA SIG are those of the SIG or SIG members and do not represent official policy of ABA International or other official body.
For official policy of the Association of Behavior Analysis International, the reader is directed to their website, http://www.abainternational.org


ANNOUNCE: Association for Direct Instruction seeks input from practitioners using DI for students with ASDs.

Bryan Wickman, Executive Director of the Association for Direct Instruction, requests the help of those who are using Direct Instruction (Engelmann , Becker, Carnine, others- examples, Language for Learning, Reading Mastery, Distar programs, etc.) with students carrying an autism spectrum disorder diagnosis. The purpose is to find out how the DI curriculum packages are being used in the field by practitioners, and whether/what kind of modifications have been used in order to implement DI effectively. The announcement also shares plans for a DI conference specific to the topic of DI and ASDs and requests feedback on training needs. See the announcement below, and direct responses to the Association for Direct Instruction, attn. Bryan Wickman.
From: Bryan Wickman
Subject: di: ADI planning DI/Autism Conference
Date: Saturday, November 28, 2009, 1:03 PM

ADI is planning a conference to be held in Columbus, Ohio this summer; focus on using DI with ASD learners. We are looking for information programs and sequences of programs used with students diagnosed with autism. Please also detail any modifications you feel are needed to utilize the programs effectively.

We are also gathering information on which programs practitioners perceive a training need.

Thanks in advance for your assistance.

Bryan Wickman,
Executive Director
Association for Direct Instruction
PO Box 10252
Eugene, OR 97440
1.800.995.2464 voice
1.541.868.1397 fax
www.adihome.org

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Website: Practitioner Issues in Behavior Analysis SIG
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Views and news expressed in this blog or by the PIBA SIG are those of the SIG or SIG members and do not represent official policy of ABA International or other official body. For official policy of the Association of Behavior Analysis International, the reader is directed to their website, http://www.abainternational.org

 

Monday, December 14, 2009

FYI: Recent ClinicalTrials.gov listings for behavioral studies

ClinicalTrials.gov,  a service of the U.S. National Institutes of Health , is
"a registry of federally and privately supported clinical trials conducted in the United States and around the world. ClinicalTrials.gov gives you information about a trial's purpose, who may participate, locations, and phone numbers for more details. This information should be used in conjunction with advice from health care professionals..."
A research study showed up in a recent search of the database cross-referencing the key words: autistic disorder, discrete trial training
(No current listings under "applied behavior analysis" or "ABA"
For all current open trials, please visit ClinicalTrials.gov ):

Interventions for Communication in Autism Network (ICAN)

This study is not yet open for participant recruitment.
Verified by National Institute of Mental Health (NIMH), November 2009
First Received: November 20, 2009   No Changes Posted
Sponsor:       National Institute of Mental Health (NIMH)
Information provided by:      National Institute of Mental Health (NIMH)
ClinicalTrials.gov Identifier:     NCT01018407
Purpose

The goal of this project is to compare the efficacy of two interventions for improving spoken language and reducing symptoms of autism.
Condition: Autism
Intervention:
Behavioral: Discrete Trial Training
Behavioral: Interpersonal Developmental Approach
Study Type:      Interventional
Study Design:     Treatment, Randomized, Open Label, Parallel Assignment, Efficacy Study

For full study details, such as intervention and assessment details, eligibility, locations, etc.,
please see the full description.
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Website: Practitioner Issues in Behavior Analysis SIG
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Views and news expressed in this blog or by the PIBA SIG are those of the SIG or SIG members and do not represent official policy of ABA International or other official body. For official policy of the Association of Behavior Analysis International, the reader is directed to their website, http://www.abainternational.org

Saturday, December 12, 2009

NEWS: CNN reports on ABA-autism best-outcome story

CNN's Kiran Chetry reported on the American Morning program earlier this week of an autism treatment success story due to an early intensive applied behavior analysis, aka "ABA" or "EIBI", therapy program...and a video accompanying the story tells a million words.

Jake Exkorn was diagnosed with autism at 2, and after two years of an intensive ABA/EIBI program was able to have diagnosis removed. Now at the age of 13, Jake is a typical teen. Significantly, his parents chose applied behavior analysis/ABA because it was the scientifically evidenced treatment, and the treatment recommended to them. to start as soon as possible and as intensively as they could afford, by an expert in the field of autism and autism treatment.

Video 5:46 (there may be a brief commercial intro):





From the story,
“...He hit all of the developmental milestones. He walked, he talked, he played,” says Jake’s mother Karen Exkorn. But at 17 months, Karen says the light began to fade from Jake's face..'I knew that I wanted treatment for Jake that had science behind it. And a lot of treatments don't. But the one that had the most science behind it was a treatment called ABA.'...Day after day, 40 hours a week, they plugged away – hoping to help Jake relearn what autism had taken away.
'Going into this there were no guarantees. Nobody ever mentioned the word recovery to us so that wasn't our goal ever.'...After a year of ABA therapy, Jake showed progress. Then, at age four – a turning point. When Karen took him for ice cream, without prompting, Jake told the man what flavor he wanted: 'Nilla.'
'The man had no idea that this was this defining moment in my life, but this was huge. This was huge. And this marked the beginning of spontaneous language for Jake.'
What soon followed was an even bigger milestone. At Jake's 4 year check-up, Karen was told her son no longer had symptoms of autism. The doctor said Jake had recovered...."
FULL ARTICLE

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Note: Some legitimate points are raised in the reader comments at CNN that not all children may have the outcome in this story; at this time there are no interventions guaranteeing recovery or best outcome (as Jake's mother herself notes in the story), however behavior analytic interventions are currently the most scientifically evidenced and have an established track record as a treatment of choice for children with autism. Other comments were about lack of availability through public programs or insurance reimbursement, and even when available through private pay, of the inability to afford or finance an ABA therapy program of the intensity that Jake's family was able to apply. On an encouraging note, many commenters also shared that they know, have a family member, or have a child themselves who was able to have removal of diagnosis, development of typical skills and function, or significant improvement in ability and quality of life by application of an intensive ABA/EIBI therapy program.

ANNOUNCE: Early Registration for 2010 ABA International Autism Conference Ends Soon!


The Association for Behavior Analysis International (ABAI) has sent out a reminder of the December 18, 2009 early registration deadline for the two-day single-track event,

Translational Science and Effective Practice
Friday, January 22 – Sunday, January 24, 2010
Location: Hyatt Regency Chicago


( To obtain the special group rate for accommodations at the time of reservation, attendees must mention that they are with the Association for Behavior Analysis International. Cut off date for the group rate is December 30, 2009, although it is recommended that reservations be made as soon as possible).

BACB & APA CE credit is available for the presentations

An abbreviated description of the Autism Conference is below.

Friday January 22, 2010
Evening
  • Opening Reception, 
  • Poster Session 1
  • Exhibitors, Bookstore, and 
  • Author Signing Fair (8:00 p.m. – 9:00 p.m.)
Saturday January 23, 2010
Opening Remarks
Morning session
Chair: Gregory P. Hanley, Ph.D., BCBA (Western New England College)
Afternoon session
Chair: William L. Heward, Ed.D., BCBA (The Ohio State University)
Evening
Sunday January 24, 2010
Morning session
Chair: Travis Thompson, Ph.D. (University of Minnesota)
For questions or assistance, please contact  convention@abainternational.org.

Association for Behavior Analysis International
550 West Centre Ave, Suite 1
Portage, MI 49024
Phone: 269-492-9310
Fax: 269-492-9316
http://www.abainternational.org

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Website: Practitioner Issues in Behavior Analysis SIG
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Views and news expressed in this blog or by the PIBA SIG are those of the SIG and SIG members and do not represent official policy of ABA International or other official body. For official policy of the Association of Behavior Analysis International, the reader is directed to their website, http://www.abainternational.org

Friday, December 11, 2009

NEWS: Behavioral Training Improves Connectivity and Function in the Brain

 Sat. 12/12/09 - added NPR All Things Considered radio interview of Marcel Just, where he discusses the importance of the intensity of the repeated reading practice applied to the children in the study experimental group, as well as the significance of white matter of the brain in synchronizing signals between different areas of the brain. The quality of the improvement of white matter correlated with the improvement in reading ability in the experimental group, and that reading programs of typical intensity did not effect these improvements. The program also touches on other skills and psychiatric disorders, including autism, that are influenced by the quality of white matter found in the brain.



A newly published study in Neuron shows that neuronal myelination and connectivity, as detected by diffusion tensor imaging (DTI). is enhanced by intensive behavioral training.





Children with poor reading skills who underwent an intensive, six-month/100 hour training program to improve their reading ability showed increased connectivity in a particular brain region, in addition to making significant gains in reading, according to a study funded in part by the National Institute of Mental Health (NIMH). The study was published in the Dec. 10, 2009, issue of Neuron.


While the relationship between training, performance and brain function has been well known, the significance is that the diffusion tensor imaging (DTI) neuroimaging was able to show specific changes within the brain of improvements towards typical structures and suggest what those improvements consist of,

"We have known that behavioral training can enhance brain function." said NIMH Director Thomas R. Insel, M.D. "The exciting breakthrough here is detecting changes in brain connectivity with behavioral treatment. This finding with reading deficits suggests an exciting new approach to be tested in the treatment of mental disorders, which increasingly appear to be due to problems in specific brain circuits.

One of the study authors, Carnegie-Mellon researcher Marcel Just, reiterated Director Insel's point,
"Our findings support not only the positive effects of remediation and rehabilitation for reading disabilities, but may also lead to improved treatments for a range of developmental conditions related to brain connectivity, such as autism," noted  Just."

The article is, Keller, T.A.& Just, M.A. Altering cortical connectivity: Remediation-induced changes in the white matter of poor readers. Neuron, 64(5), 624-631.
doi:10.1016/j.neuron.2009.10.018

Summary/Abstract
Neuroimaging studies using diffusion tensor imaging (DTI) have revealed regions of cerebral white matter with decreased microstructural organization (lower fractional anisotropy or FA) among poor readers. We examined whether 100 hr of intensive remedial instruction affected the white matter of 8- to 10-year-old poor readers. Prior to instruction, poor readers had significantly lower FA than good readers in a region of the left anterior centrum semiovale. The instruction resulted in a change in white matter (significantly increased FA), and in the very same region. The FA increase was correlated with a decrease in radial diffusivity (but not with a change in axial diffusivity), suggesting that myelination had increased. Furthermore, the FA increase was correlated with improvement in phonological decoding ability, clarifying the cognitive locus of the effect. The results demonstrate the capability of a behavioral intervention to bring about a positive change in cortico-cortical white matter tracts.
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References:
Image source: Timothy Keller, Ph.D.; Marcel Just, Ph.D.

National Institute of Mental Health (NIMH)
Press Release
December 09, 2009
Behavioral Training Improves Connectivity and Function in the Brain

Keller, T.A.& Just, M.A. Altering cortical connectivity: Remediation-induced changes in the white matter of poor readers. Neuron, 64(5), 624-631.
doi:10.1016/j.neuron.2009.10.018

Excellent media article on the study with background info on brain white matter research and its significance in other skills, IQ, and psychiatric disorders, as well as recent research demonstrating levels of brain plasticity thought improbable in the relatively recent past.
Learning, adaptation can change brain connections, CMU researchers say
Thursday, December 10, 2009
By Mark Roth, Pittsburgh Post-Gazette

March/April 2006
MIT Technology Review
Diffusion Tensor Imaging

Diffusion Tensor Imaging (.pdf)
www.usa.siemens.com/medical
MRI Hot Topics
Keith Heberlein, PhD, John Grinstead, PhD, Heiko Meyer PhD,
Christopher Boyea, MBA, RT(R)(MR), Milind Dhamankar, MD,
Siemens Medical Solutions, USA

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Website: Practitioner Issues in Behavior Analysis SIG
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Views and news expressed in this blog or by the PIBA SIG are those of the SIG and SIG members and do not represent official policy of ABA International or other official body. For official policy of the Association of Behavior Analysis International, the reader is directed to their website, http://www.abainternational.org

Wednesday, December 9, 2009

NEWS: Ohio House Passes Autism Insurance Reform Legislation

**1/24/10- Update: According to the Ohio Legislative Service Commission, the status of HB 8 is that it is currently in the Senate Committee on Insurance, Commerce & Labor**
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The Ohio House of Representatives on Tuesday December 8, 2010 passed an amended House Bill 8

Representatives Ted Celeste (D-24), Nancy Garland (D-20) + 42 co-sponsors introduced 02/17/09
As Passed by the House, 128th General Assembly, Regular Session, 2009-2010
   
Am. Sub. H. B. No. 8"
"A BILL
    To amend section 1739.05 and to enact sections 1751.68 and 3923.84 of the Revised Code to prohibit health insurers from excluding coverage for specified services for individuals diagnosed with an autism spectrum disorder..."
Applied behavior analysis is included in HB 8; some clauses of interest regarding delivery and provider of services,

     "(a) The person is licensed, certified, or registered by an appropriate agency of this state to perform the services assigned to the person in the treatment plan.
    (b) The person is directly supervised by an individual who is licensed, certified, or registered by an appropriate agency of this state to perform the services assigned to the person in the treatment plan. "

About who determines medical necessity
"(B) Coverage provided under this section shall be delineated in a treatment plan developed by the attending psychologist or physician and shall not be subject to any limits on the number or duration of visits an individual may make to any autism services provider, except as delineated in the treatment plan, if the services are medically necessary."

Some online comments are that last-minute amendments added to the bill set a $36,000/year cap on coverage, review of treatment plan by the insurer every 6 months, and a mandate that treatment be provided, or overseen by, a licensed, certified or registered provider, and delayed the implementation date to January 2011. There are limits on the type of plan to which H.B.8 would apply, and insurers would be allowed to opt out if the mandate increases insurer costs or premiums by more than 1%. To date, other states with similar coverage have reported cost increases of 0.8% or less.


H.B. 8 now goes to the Ohio Senate for consideration.

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Other stories and references:

Ohio General Assembly

Ohio Legislative Service Commission


House OKs bills on autism, diabetes
Wednesday,  December 9, 2009 3:02 AM
Jim Siegel
THE COLUMBUS DISPATCH


Notice of passage of HB 8 at Autism Votes 
with additional information on past insurance legislation activity in Ohio

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Website: Practitioner Issues in Behavior Analysis SIG
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Views and news expressed in this blog or by the PIBA SIG are those of the SIG and SIG members and do not represent official policy of ABA International or other official body. For official policy of the Association of Behavior Analysis International, the reader is directed to their website, http://www.abainternational.org