The North Carolina Joint Study Committee on Autism Spectrum Disorder and Public Safety is currently deliberating feasibility of drafting insurance reform legislation to be submitted within the legislative session commencing May 12, 2010. This legislation would propose to cover the diagnosis and treatment of autism, including applied behavior analysis.
At the most recent meeting on March 4, 2010 an actuarial cost estimate by the firm of Oliver Wyman was presented to the Committee by Marc Lambright, FSA, MAAA. Other presentations were made by Blue Cross/Blue Shield, the North Carolina Chamber of Commerce, and the State Health Plan. The arguments of Blue Cross/Blue Shield turned on the nature of applied behavior analysis, which they argue are educational, not medical, and on their cost estimates which they believe are in the range of $2.37-$11.00/month/policy. The analysis by Oliver Wyman disagrees with those estimates, saying that real costs for states which have passed this type of coverage are more in the range of 0.4%/policy/month or $1/month.
Previous testimony on given to the Committee on February 3, 2010 was an overview of Autism Spectrum Disorder by Dr. Rob Christian, Clinical Assistant Profession of Pediatrics and Child Psychiatry at the Carolina Institute for Developmental Disabilities; a parent perspective by Bev Moore, Secretary of the Autism Society of North Carolina Board of Directors; insurance initiatives in other states and the cost-benefit of removing exclusion of coverage for autism treatment by Lorri Unumb, Senior Policy Advisor for Autism Speaks; and the experience as both a parent and a medical professional on the hardship of insurance loss upon autism diagnosis by Dr. David Kaylie, FACS, of the Duke University Medical Center.
HB 5425 would address different issues related to special education, and includes a clause related to a provision of applied behavior analysis to students with autism diagnoses whose IEPs call for such, provider qualifications for those services and one mechanism to increase pool of providers.
The text relevant to the practice of behavior analysis can be found in Section 2., page 5, [lines 127-158] Text is reformatted for readability; please consult bill for original.
Start of clause,
Sec. 2. (NEW) (Effective July 1, 2010)
(a) On and after July 1, 2012, local and regional boards of education shall provide applied behavior analysis services to those students with autism spectrum disorder whose individualized education plan or plan pursuant to Section 504 of the Rehabilitation Act of 1973 requires such services.
Such services shall be provided by a person who is
(1) subject to the provisions of subsection (b) of this section, licensed by the Department of Public Health or certified by the Department of Education and such services are within the scope of practice of such license or certificate, or
(2) certified by the Behavior Analyst Certification Board as a behavior analyst or assistant behavior analyst, provided such assistant behavior analyst is working under the supervision of a certified behavior analyst.
For purposes of this section, "applied behavior analysis" means the design, implementation and evaluation of environmental modifications, using behavioral stimuli and consequences, including the use of direct observation, measurement and functional analysis of the relationship between the environment and behavior, to produce socially significant improvement in human behavior.
(b) If the Commissioner of Education determines that there are insufficient certified personnel available to provide applied behavior analysis services in accordance with the provisions of subsection (a) of this section, the commissioner may authorize the provision of such services by persons who:
(B) coursework that meets the eligibility requirement to sit for the board certified behavior analyst examination;
(3) are supervised by a board certified behavior analyst.
(c) Nothing in this section shall be construed to require the provision of applied behavior analysis services in an individualized education plan or plan pursuant to Section 504 of the Rehabilitation Act of 1973.
"Sec. 12. (NEW) (Effective July 1, 2009) On or before January 1, 2010, the Attorney General, in consultation with the Commissioners of Education and Higher Education, shall report, in accordance with the provisions of section 11-4a of the general statutes, to the joint standing committee of the General Assembly having cognizance of matters relating to education on any investigation conducted regarding behavior analysis services for children with autism spectrum disorder performed in the state. Such report shall include any findings based on such investigation, recommendations for statutory changes and recommendations for an appropriate in-state certifying agency for behavioral analysis services."
This evening, March 3, 2010, the U.S. House of Representatives passed by a vote of 262 to 153, the House Committee on Education and Labor Substitute for H.R. 4247, formerly known as the "Preventing Harmful Restraint and Seclusion in Schools Act", and now renamed,
"...The Keeping All Students Safe Act would establish, for the first time, minimum federal standards to provide equal protections to all students, in every state across the country. It would make clear that physical restraint or locked seclusion should be used only when there is imminent danger of injury and only when imposed by trained staff. It would prohibit mechanical restraints, such as strapping children to chairs, misusing therapeutic equipment to punish students or duct-taping parts of their bodies and any restraint that restricts breathing.
It would also prohibit chemical restraint, which are medications used to control behavior that are not consistent with a doctor’s prescription.
The bill would prohibit school staff from including restraint or seclusion as planned interventions in student’s education plans, known as Individualized Education Programs (IEPs). It would also require schools to notify parents immediately after incidents when restraint or seclusion was used..."
If H.R. 4247 progresses to Federal law, it would apply to all public and private schools which accept Federal funding, and all states would be expected to comply with, if not exceed, the conditions specified in the bill.
