Pennsylvania HB 1150 Highlights from the 04/01/08 Public Hearing

[Guest guest]

Hello all:

I went to burg on April 1st to listen to the testimony of various

people (Estelle Richman, Sam Marshal, President, The Insurance Federation,

Shivers, State Director of the National Federation of Independent Business,

Dr. Curry, Medical Director of Blue Cross of Northeastern PA, Dr.

Foxx, Professor of Psy at Penn State burg, Gates from the

Pennsylvania Health Law Project, Bouder, Chief Operating Officer of The

Vista Foundation, Ms. Kim Motosicky, a parent and Ms. Pennsylvania 2007 Ms.

. Everyone did a great job presenting ,

I have been chatting with Jim Bouder on line and asked him if I could

forward his slide presentation that he presented at the hearing on April 1st and

he

said it was okay. I would like to mention a few key points that were

mentioned by others. I typed up some pieces of their testimony which I thought

were their key points:

Sam Marshall:

" At the outset, I'll state the obvious - we oppose this Health Insurance

mandate even as we recognize the need for and the value of treatment for

children with Autism. "

" Pennsylvania has already made the commitment to providing this

treatment through the extensive coverage already provided to all children

through the

Department of Public Welfare, with a program that is widely regarded as the

most generous and innovative in the country. Whatever happens with this

bill, we assume -- not just as insurers, but as parents, citizens and taxpayers

-- that this commitment will remain. "

Shivers:

" There was significant debate in the state House last years as to who

exactly would be affected by HB 1150 and who would benefit from the proposed

mandate. There was also wide disagreement on the costs associated with these

coverage mandates. "

" National Federation of Independent Business's small-business members tell

us that our current healthcare system and the way we pay for it is their number

one concern. Nearly

two-thirds of the working Pennsylvanians with no health insurance are in

some way tied to a small business. Additional, the small-business community

pays, on average, 18 percent more in health insurance premiums for the same

benefits as those in the largest firms. "

" A similar amendment was rejected in the state House because it was too

costly. The Public Employee Benefit Trust Fund covers most state workers.

They

suggested such a mandate would cost more than $9 million. If the General

Assembly is not willing to include state workers under the mandate because of

the cost - how can it justify the impact on small employers. "

Gates:

" I would like to also dispel the myth that Medical Assistance currently

covers clinically appropriate services for children on the autism spectrum

who do qualify for Medical Assistance. It is true that many children with

autism have been prescribed what is commonly knows as " wraparound " services

because that is what is covered by Medical Assistance. However, " wraparound "

is a

model designed for children with traditional mental disorders - not autism.

Part of the problem is that with the medical necessity criteria used under

Medical Assistance to determine coverage for wraparound. The medical

necessity criteria for wraparound makes it difficult to obtain both the

intensity and

duration of services needed for children with autism. "

" Even if a family is able to get authorization for wraparound under the

mental health standards of medical necessity, the services are frequently not

tailored to the needs of children with autism. The knowledge and experience

of direct care staff (called TSS) has been of particular concern to many

families. While there are training and experienced requirements for TSS's,

since wraparound is not an autism service, there is not requirements of either

training in autism interventions nor experience working with children with

autism. "

" As a result, many parents of children with autism spectrum disorders are

forced to train their child's staff themselves only to find those staff people

moving to a higher paying jobs once they become experienced. "

" In summation, while there are many children with autism spectrum

disorders receiving wraparound services, it is not because those services are

appropriate but rather because, aside from some good school programs, they are

the

only services available. HB 1150 would open up funding for autism specific

services and encourage agencies and their staff to become trained and

experience in serving children with autism without the limitations inherent in

Medical Assistance. "

Gates entire testimony was wonderful but it is impossible for me to

type the entire document so I tried to take what I felt was key.

Bouder:

-Rather than type all the key points, which would not provide it justice

because it was awesome, I asked Jim if I could attach it so you could see,

in detail, what he presented mathematically to the Senate Banking and

Insurance Committee Public Hearing. He asked me to mention the following key

points:

1. HB 1150 will cost insurance ratepayers little more than $1.60 per month.

2. PA Chamber of Commerce and insurance company estimates between 4% and 8%

are mathematically impossible - not enough kids with autism in PA and the

bill has $36K cap.

I was so glad that I attended the Public Hearing and will continue to follow

it. Please take the time to contact your Senators about this important bill.

If you are not able to open the pdf file or it was not attached, please

email me privately and I will forward it to you.

Thanks,

Bonita McCabe

Mother to Anne - 11 year old PDD-NOS

**************Planning your summer road trip? Check out AOL Travel Guides.

(http://travel.aol.com/travel-guide/united-states?ncid=aoltrv00030000000016)