RE: [SPAM] Re: 5 days to the input meeting!!!!

[Guest guest]

Well, for purposes of the letter, don’t mention that. Just talk about

The issues as if you had a fully funded plan. ;-)

THANK YOU!

(Who knows, one day the ERISA laws may model on what Texas

Does now. . . .)

From: Texas-Autism-Advocacy

[mailto:Texas-Autism-Advocacy ] On Behalf Of

Sent: Thursday, December 13, 2007 10:11 PM

To: Texas-Autism-Advocacy

Subject: [sPAM] Re: 5 days to the input

meeting!!!!

, if we have an ERISA plan, does any of this apply? I started

editing the letter and realized it probably doesn't apply to our

family. Is that right? Not that I don't support the premise on

behalf of other families, but I would need to write a different

letter I guess.

Regards,

>

> Christmas is so near with so much to do

>

> Don't tell me. Ugh! Another advocacy letter is due?!?!?

>

> Only 5 days until the stakeholders meeting is here

>

> SO please take a minute to lend your voice loud and clear.

>

> Consumers must make their issues known without a doubt

>

> Or the insurance lobby will make sure that we all get left out.

>

> Just use this sample letter here below

>

> To send in your comments so that their in-boxes overflow!!!

>

>

>

> by e-mail: Margaret.Lazaretti@...

> <mailto:Margaret.Lazaretti%40tdi.state.tx.us>

> or fax:

> or snail mail: Hobby 1, Room 1350, MC 113-1A

> P.O. Box 149104; Austin, TX 78714-9104

>

> RE: HB1919, amendment 1

>

> Dear Ms. Lazaretti:

> Thank you for the opportunity to give input on the drafting of the

> regulation for HB1919. I am a (STATE WHY YOUR INTERESTED IN THIS

HERE: i.e.

> parent/grandparent/provider) of a child with autism. I read the law

with

> great interest because it addresses mainly problems that I have

experienced

> in obtaining insurance coverage for my child's medically necessary

treatment

> of symptoms related to autism spectrum disorder.

>

> THIS NEXT SECTION IS WHERE YOU STATE WHERE YOU WANT A MORE DETAILED

> EXPLANATION. THIS SHOULD VARY PERSON TO PERSON, SO I WILL GIVE

SEVERAL

> OPTIONS BASED ON QUESTIONS THAT PEOPLE HAVE ASKED ME THAT YOU

CHOOSE YOUR

> TOP THREE TO INCLUDE IN YOUR LETTER AND DELETE THE REST.

>

> MANDATED BENEFITS

> I noticed that the bill includes a statement that (

states " . .must

> provide . . . for all generally recognized services prescribed in

relation

> to ASD by the enrollee's primary care physician. . . " where as

> © states " 'generally recognized services' may include. . . " and

then a

> list. Does this mean that only the services on the list are

considered

> " generally recognized services " ? The intent of the bill seems to

provide

> for more than those in the list. I have had a huge difference of

opinion on

> what is experimental versus generally recognized. I strongly feel

that TDI

> needs to include a definition of " generally recognized services " or

> otherwise there will be a great deal of appeals and

misunderstanding about

> this phrase. There also needs to be clarification as to whether the

intent

> was to limit the services to those listed in the bill or other

services that

> are " generally recognized " could be prescribed by a PCP.

>

> DOES MANDATE TRUMP 'EXPERIMENTAL' ARGUMENT FOR ABA?

> From my experience, I have found that one area it seems need further

> clarification is the phrase " health care plans must provide " . When

I called

> my plan to see how the new benefit will apply, the customer service

> representative did not even know about this bill or it's

requirements. I

> asked specifically about ABA, and I was told that ABA is considered

> experimental. I understand " must " from the bill to override this

objection

> as the bill specifically states that applied behavior analysis is

generally

> recognized.

>

> DOES MANDATE TRUMP 'RESTORATIVE'SPEECH ARGUMENT?

> When I tried to see if the bill would apply to speech benefits, I

was told

> that insurance only has to pay for services that are 'restorative'

in

> nature. Does the mandate " health care plan must provide coverage "

override

> this requirement? Amendment 1 makes no mention of this distinction

as to

> why the speech deficit requires the service, only that it needs to

be

> provided.

>

> CLARIFICATION AS TO WHAT IS BEHAVIOR TRAINING AND BEHAVIOR

MANAGEMENT

> The bill lists 3 type so behavior services. As a parent when I read

the

> bill, I'm confused by the difference between the three. What is

applied

> behavior analysis versus behavior training versus behavior

management. It

> would be helpful for the regulation to list specific definitions or

examples

> or codes that would give a clearer picture as to the difference

between

> these.

>

> MEDICATIONS AND NUTRITIONAL SUPPLEMENTS

> I buy some of my nutritional supplements OTC and some of them

through my

> doctor's office. Most of them are not from pharmacies. Will all of

these

> be reimburseable as long as I have my pcp's prescription?

>

> FOR BCBAs AS PROVIDERS

> The bill states that a provider can be someone who is certified as a

> provider under TRICARE. When I called my insurance company to start

the

> process to have the Board Certified Behavior Analyst (BCBA) apply

to be an

> in network provider, the insurance company told me that the person

needed to

> be licensed. When I explained that what the law stated, the

insurance

> company then stated that the person had to be at least a master's

level.

> The BCBA is a master's level, but the insurance company didn't seem

to know

> what to do about a person who had a cerfication but no license. TDI

needs

> to specify which documents insurance companies can request from a

provider

> to make sure that he meets the requirements of an amendment 1

provider.

>

> NON BCBAs PROVIDING ABA

> Even though applied behavior analysis is a sub-specialty in

psychology, most

> psychologists do not know enough about ABA to supervise a program.

In fact

> the professional group of behavior analysts have put out a

Consumer's

> Guidelines document which clearly spells out the minimum experience

that a

> professional who doesn't have a BCBA must have in order to direct

an ABA

> program. I am concerned that because there are very few BCBAs that

people

> who don't know anything about ABA will be approved as either service

> providers or be the ones who approve plans of care. Could TDI

specify the

> level of knowledge needed (even adopt the consumer guidelines) for

someone

> to supervise an ABA program and to approve a plan of care? As ABA

is a

> fairly new service for many companies, I am concerned that this is

not at

> all clear.

>

> Thank you for your work in helping Texas consumers of insurance!

>

> Sincerely,

>

>

>

>

>

>