From the Detroit News:

Blue Cross Blue Shield of Michigan has announced plans to offer coverage for Applied Behavioral Analysis (ABA) for children with autism who are between 2 and 5 years old.

The announcement comes as the insurer is being sued over its previous refusal to cover ABA claims. The company had maintained that ABA is unproven.

The coverage will consist of 60 sessions per child, and will be available for purchase by groups that already cover outpatient mental health coverage. The insurer plans to begin offering the coverage July 1, pending regulatory approval.

In the New York Times ‘Room for Debate’ blog, a conversation among experts about claims of fraud associated with skyrocketing federal disability costs.

Officials say the government can realize huge savings by eliminating fraud, abuse and waste in Medicare, Medicaid and the Social Security disability insurance program. The president’s 2010 budget proposes to spend $4.3 billion over five years attacking the problem.

But is fraud really the cause of rising costs?

Jennifer L. Erkulwater, of the University of Richmond, says no. She says changes in disability criteria have made more people eligible for benefits.

Richard V. Burkhauser, of Cornell University, says the existing system offers people with disabilities financial incentives to stop working, and needs to be reformed.

Morley White, an administrative law judge in Cleveland for the Social Security Administration, says there is too much emphasis on alleged fraud and not enough on reforming the system.

See also:

Budget targets frauds and errors in social programs — Wall Street Journal The White House estimates that every dollar spent chasing fraud in Social Security will save $11 in erroneous payments.

From the Austin American-Statesman:

Owners of an Austin-area clinic which treats children with autism using controversial techniques say the center is facing a financial crisis in the wake of investigations by three major insurers. The Texas Medical Board is also investigating the clinic’s medical director.

Co-owner of the CARE clinic Kazuko Grace Curtin says they have treated more than 5,000 patients from around the world since 2003. Among charges disputed by insurers is the clinic’s use of chelation, which is not approved by the FDA for treating autism. Doctors say it is risky and has not been proven effective.

The clinic performs more than 20 tests on each child for a variety of ailments, at a cost of “several hundred dollars” each. Curtin said the clinic had “cured many kids.” Doctors urged parents to be cautious, since autism is a condition without a known cause or cure.

A study in the current issue of Pediatrics concludes that nearly 40 percent of children with special health care needs are not adequately insured. Emerging insurance products may expose children and families to greater financial risk by siphoning off healthy members from the risk pools that conventional plans use to establish their premiums.

Researchers led by Paul W. Newacheck of the University of California at San Francisco urged that health care providers, insurers, employers, and government should collaborate to ensure that all children have health insurance that meets their needs.

Judith Graham writes in the the Chicago Tribune Triage blog that a new Illinois law will require insurance companies to provide “habilitative” therapies for youngsters with developmental disabilities to gain new skills. Previously, coverage was limited to children receiving “rehabilitative” therapies to recover lost skills.

Coverage will be extended to children with cerebral palsy, autism, Down syndrome and other developmental disorders. The law will require insurers to pay for speech, physical and occupational therapies for such children up to the age of 19.

Similar laws are on the books in Maryland and the District of Columbia. The Illinois measure will take effect on Jan. 1, 2010.

Writing in the Los Angeles Times, Sandy Banks slams a ruling by California regulators that insurance companies must pay for speech, occupational and physical therapies for kids with autism, but not for their behavioral therapies.

An excerpt:

State law says insurers must cover mental and behavior disorders the same way they cover other medical conditions. So a depressed teenager can get a psychologist’s ear, and a kid who smokes pot gets rehab treatment — and that is as it should be.

But an autistic child doesn’t merit a professional’s help to learn how to share a crayon or ask a classmate for a play date? That doesn’t seem fair to me. Or to their families.

Earlier post here.

From the Los Angeles Times:

In a letter issued this week, California’s Department of Managed Health Care said that insurers must provide speech, occupational and physical therapies for autism, but are not required to pay for applied behavior analysis.

Parents have argued that the behavior therapy, which can cost as much as $70,000 a year per person, is needed to help their children gain the skills they need to live in society. They maintain that failure to provide the therapy is a violation of  the Mental Health Parity Act.

Insurers say applied behavior analysis is an educational service, not medicine, and that covering it would drive up insurance costs for everyone.