We are looking at Autism, not so much the various degrees of Autism, but in treating it and how it can be next to impossible to get all the best treatment for this condition due to insurance billing, but mostly at Medicaid and the problems associated with the Autistic diagnosis.
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When you have an average of 1 in every 110 children having an Autism Spectrum Disorders (ASD) which is more now than ever before, you might think that this condition ought to be covered under most insurance. Quite the opposite is true. There is no known cure for ASD but they can be treated with behavioral and educational interventions and the earlier the treatments the better. Often times these patients have to be given expensive medications, therapies like speech, occupational therapy and physical therapy along with behavioral analysis.
All insurance companies and HMOs subject to the mandate must be incompliance by April 1, 2010. Most employer sponsored plan years start at the beginning of the plan sponsor’s fiscal year, which in many cases is January 1st. The mandate requires coverage for diagnosing and treating autism spectrum disorders subject to aggregate dollar limits per child of $36,000 annually and $200,000 lifetime
Well they are not completely compliant. They will find a behavioral diagnosis in which to treat autistic patients, not one that falls into ASD. It seems to come back to money too.
The supplemental Medicaid waiver will not help any Floridians without further approval and funding by our legislators.
So why should be surprised to hear that just in December of 2011
When Gov. Rick Scott unveiled his proposed $66.4 billion budget last week, many people in the capital and around the state cast it as schools versus hospitals.
Scott’s spending plan injected public education with a roughly $1 billion increase but cut $2.1 billion in reimbursements for Medicaid. The cut prompted a fast pushback from the Safety Net Alliance of Florida, a lobbying group that represents 15 of the state’s biggest hospitals. It estimates the cuts would cost its members $1.4 billion.
Tea Party member Scott no only gave a cut to Medicaid – but he is refusing federal funds.
The group estimated that Shands Jacksonville would face a $13.6 million cut in Medicaid reimbursements under Scott’s proposed budget. Shands Gainesville would face a $63.5 million reduction. The biggest overall cut: $152.7 million at Jackson Memorial Hospital in Miami.
The ones having to pay for this are the Florida tax payers. Funding is just a part of the problems for people dealing with ASD. You also have to pass the logistics of the billing diagnosis.
You can be reimbursed by Medicaid for counseling Medicaid parents and/or children for mental health issues or behavioral problems. But, only if you code and bill it correctly.
This was a problem I encountered. There is not a “billing code” for the ASD. My son was in a critical care unit for behavioral issues, and though the director said that the problem was in the billing of my son (his diagnosis was Pervasive Developmental Delay – PDD) and could not be treated for the ASD of PDD. Now my son has a number of other BEHAVIORAL diagnoses like ADHD, impulsivity, and a defiant disorder which the connecting out-patient clinic was treating him for. But because he has PDD I was told the Psychiatrist could not treat him. It is rather Ironic that the complaint I had made was answered that my son did not qualify for being baker acted though it was the police that found him qualified as being so. The response said nothing about billing, but rather focused on the idea that my son did not need the care that the police deemed he was qualified for. If my son had been able to be
BILLED accordingly – then I think they would have kept him.
I spoke to Robin Elle Lord who was over the psychological diagnosis division of Medicaid. She informed me also of the approval made to include ASD as part of the psychological division of diagnosis accepted by Medicaid, but she said the problem is they have not done it yet… not in FL. I do not exactly know what is delaying the process. I am investigating and on Friday 3-28-12 I went to a Center for Autism and Related Disabilities (CARD) orientation. They offer many services and referrals for free. I am requesting for them to put me in contact with those who went to the capital to request more funds for the program. Since many of the programs for those with ASD are not covered under Medicaid - I have had to enroll in the CMS program, which still needs funding to help patients, but offer services for those disabilities not covered under Medicaid. I feel sometimes like I have to jump through hoops just to get my son and our family the help we need. It's hard enough having a very special needs child at home without struggling and fighting for good care for him.
Contact Governor Scott.
Office of Governor Rick Scott State of Florida
The Capitol 400 S. Monroe St. Tallahassee, FL 32399-0001.
(850) 488-7146.
http://www.ncsl.org/...
http://www.autismvotes.org/...
http://www.centralreach.com/...
http://jacksonville.com/...
http://www.cchap.org/...
http://www.centerforautism.com/
http://www.momsfightingautism.com/...
http://www.leg.state.fl.us/...
http://ahca.myflorida.com/...
http://apd.myflorida.com/
http://www.cms-kids.com/