Autism Insurance Mandates Trigger Influx Of Service Providers
COLUMBUS, Ohio — An Indianapolis company is bringing two autism therapy centers to central Ohio as part of a plan to ultimately open 20 sites and provide about 1,000 jobs across the state.
The Hopebridge centers, slated to open in late April in Dublin and Westerville, are among 10 the company plans to have to operate within a year, said chief executive Dennis May.
Four have already opened: three in the Cincinnati area and one outside Dayton. Other centers are planned for Akron, Cleveland, and Toledo. They join a network of 17 Hopebridge clinics across Indiana and Kentucky.
The expansion comes after an Ohio law went into effect last April requiring individual and group insurance plans to cover kids 14 and younger for autism-spectrum screening, diagnosis, and treatment. Advocates say a key element of the law is its inclusion of applied behavior analysis, or ABA, which uses techniques based on human-behavior principles, such as prompting a child to imitate and repeat the desired behavior several times, offering rewards each time it is performed correctly.
Similar law changes have happened in 45 other states, leading to spikes in service providers, particularly those offering ABA, which has proven effective but has long been denied by insurance companies, said Lorri Unumb, vice president of state government affairs for Autism Speaks.
“It’s such a wonderful thing,” Unumb said. “This not only expands access or creates access for children with autism and will change the trajectory of their lives forever, but it also spawns new business.”
Hopebridge, which offers ABA, factored the law change into its decision to expand into Ohio, May said. Access to care also was a consideration.
“There’s really a shortage of the number of providers for the number of children, the size of the state and the need in the state,” May said. “We’re excited to support those families that have needs.”
Marla Root of the Ohio Autism Insurance Coalition said the group works to introduce providers to Ohio.
“We definitely have already seen some providers from other states looking to come into Ohio, absolutely, and we’re hoping that’s the case,” she said. “We have a lot of need and, especially, we have a lot of underserved areas.”
Some providers, however, continue to hang back as Ohio works to include ABA as a Medicaid benefit, Root said.
The change in law also has led to an increase in demand, exacerbating the need for more providers, said Melissa Bacon of the Ohio Center for Autism and Low Incidence. There have been new providers, she said, but it takes time to obtain needed certifications and approvals.
“It’s not like you can just turn a switch on and have that happen,” said Bacon, who directs policy, strategic initiatives and stakeholder engagement.
The federal Centers for Disease Control and Prevention reports that 1 in 68 children has been identified as having autism spectrum disorder, a developmental disability that can cause social, communication and behavioral challenges.
May said the Hopebridge clinic-based model is different from other providers that offer in-home treatment because it gives kids the space needed for therapy as well as social interaction with other children. The centers also offer comprehensive, collaborative care, with one-stop access to speech, occupational and physical therapies as well as ABA, he said.
Speech, occupational and physical therapies were generally covered before law changes, Unumb said, but it is significant that ABA has been added.
She said Ohio is a bit different from other states because, since 2013, ABA coverage was required for individual and small-group plans provided under the federal Affordable Care Act, also known as Obamacare.
A child with severe impairment could require 20 to 40 hours of ABA therapy each week, services that could cost as much as $70,000 a year, Unumb said. The new laws open the therapy up to children from non-wealthy families.
“It’s absolutely life-changing,” she said. “We see all over the country children who had no access to ABA therapy before making remarkable gains.”
© 2018 The Columbus Dispatch
Distributed by Tribune Content Agency, LLC