Popular autism therapy a bit closer to insurance coverage

Two recent events come as good news for parents of children with autism — some of whom have struggled to pay for an expensive therapy not now covered by state-funded insurance plans.

In a case involving three children with autism-spectrum disorders, a judge has ruled that state coverage plans can't impose a blanket exclusion on the therapy, Applied Behavioral Analysis (ABA).

And a state panel has voted to cover — with qualifications — the two most promising types of ABA therapy. The panel decides what treatments the state should cover for state employees, injured workers and people on Medicaid.

With sharply rising numbers of children with autism-spectrum disorders, the intensive one-on-one therapy — costing as much as $50,000 a year — could be a big-ticket item for the state.

And partly because the therapy is so individualized, there's a lack of large studies on its effectiveness.

Most insurers, including the state, either don't cover it or drastically limit coverage, and legislative attempts to force coverage haven't been successful here.

Many parents and practitioners in the autism field believe ABA therapy is the most successful therapy for children with autism.

While typical children learn from imitating their parents or other adults, children with autism don't, and must be taught many of the behavioral skills needed for social interaction, such as eye contact, speech and attention.

While many questions remain, the two decisions have opened a window for parents seeking coverage.

In the first, King County Superior Court Judge Susan Craighead last month ruled that the state Health Care Authority's blanket exclusion conflicts with the state's Mental Health Parity Act. That act says mental-health treatments must be covered like physical-health treatments, when medically necessary for a patient.

The court has not yet decided on the case's class-action status.

More recently, the state's Health Care Technology Clinical Committee voted 7-2 that while effectiveness of ABA is unproved, two of six types of the therapy should be covered, so long as the children are enrolled in a research trial.

The committee will provide details about that requirement after seeking advice from experts.

"It was the best possible outcome," said Arzu Forough, the mother of two boys with autism-spectrum disorders.

Forough, state representative for Autism Speaks, a national organization working to change coverage laws, said she and others were discouraged going into an earlier meeting of the committee, because many reports had recommended against coverage, noting scanty evidence of effectiveness.

Dr. Bryan King, a psychiatrist who works with children with autism, told the committee there is broad consensus in the field that such interventions can be very helpful.

King, who was speaking on his own behalf, heads the Autism Center at Seattle Children's hospital.

Dr. Sara White, clinical director of the Sendan Center in Bellingham, told the committee the therapy would save money in the long run.

It's far better for the child, the family and society if a child can learn skills early to avoid needing intensive, lifelong management and care, she said.

However, White said, a lot depends on how children are to be enrolled in a research trial, and whether only children living near large academic centers would qualify.

The Health Technology Assessment Clinical Committee will announce details of the research requirement at its Sept. 16 meeting.

Carol M. Ostrom: 206-464-2249 or costrom@seattletimes.com