2009-08-27 / Opinion

Parent hails state's autism coverage law

BY DAVE BENJAMIN Staff Writer

New Jersey residents who have children with autism and who must pay a significant amount of money for the cost of therapy will remember Aug. 13, 2009, for a long time.

Sharon Dey Sharon Dey "Aug. 13 was an emotional and victorious day for families that have children with autism," said Sharon Dey of Jackson, who is the parent of an autistic child. "If this law helps one child, the long road was worth it. But we all know it will help thousands more. The rate of autism in New Jersey is now 1 in 94 children."

Dey, who is the vice president of the Jackson Board of Education, said the new state law should benefit many families in the area.

She said coverage for Applied Behavioral Analysis (ABA) therapy is, in her opinion, the key element of the law.

"You are given a devastating diagnosis, a course of treatment by your doctors and then insurance will not cover it," Dey said. "I remember being told in 2003 by our insurance carrier that the coverage was not medically necessary."

She said the cost of therapy for children who have autism can be equal to or greater than the cost of college tuition.

Dey referenced several cases and said this form of therapy is an effective, evidence based treatment for children with autism.

"This behavioral model for my son, together with his teachers and therapists, have helped make my son the successful 9-yearold he is today," Dey said.

At the Children's Specialized Hospital, New Brunswick, on Aug. 13, Gov. Jon S. Corzine signed legislation requiring New Jersey health insurers to provide diagnostic coverage for screening for autism and other developmental disabilities.

The law also includes therapeutic services,

including any mentally necessary occupational, physical and speech therapy.

"We have made the diagnosis and treatment of autism spectrum disorders a top priority in New Jersey," Corzine said. "The legislation I am signing today recognizes there must be appropriate resources to treat and care for individuals with autism, and provide their families the support they need."

Corzine said by doing this, legislators will enable those affected with autism to function as independent, productive and empowered individuals and ease the burden on their loved ones.

According to the law, insurance companies will be required to provide up to $36,000 per year for medically necessary behavioral early intervention for all patients with autism and with other developmental disabilities, who are under 21 years of age.

Of 15 states, New Jersey is the first to include developmental disabilities along with autism in this type of insurance legislation.

Assembly Speaker Joseph J. Roberts Jr. (D-Camden) said many New Jersey families are being stretched to their financial edge.

"But without health coverage for their loved ones, countless families are bankrupting themselves just to give their child the potential for a bright future," said Roberts. "This measure offers real and meaningful hope that they will not battle alone."

Autism is a biologically based disorder that affects the development and functioning of a person's verbal and nonverbal communication skills, social interaction and behavior patterns.

Autism affects people of all races, ethnicities and socioeconomic groups and is four times more likely to be present in boys than in girls. There are no biological markers or tests that detect autism at the present time. Clinicians make the diagnosis on information from the parents and observation of the child. There is no known cause, although researchers believe that several genes possibly combined with environmental influences may be responsible.

Sen. Joseph F. Vitale (D-Middlesex) said for New Jersey families struggling to get the best care and treatment for their autistic and developmentally disabled children, this new law is about making insurance providers honor their commitments.

Vitale said whenever a treatment or therapy exists that can make a difference in the lives of children living with the effects of autism spectrum disorders or other developmental disorders, insurance providers must step up and provide coverage.

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