BILL ANALYSIS
AJR 46
Page 1
Date of Hearing: August 24, 2010
ASSEMBLY COMMITTEE ON HEALTH
William W. Monning, Chair
AJR 46 (Harkey) - As Introduced: June 29, 2010
SUBJECT : Autism in military families: funding Intensive
Behavioral Interventions.
SUMMARY : Urges the Congress of the United States to pass
legislation to fully fund Intensive Behavioral Interventions
(IBI) services through TRICARE for all military families with
children with autism and autism spectrum disorders (ASD), and
designate IBI services as a medical necessity to make services
available to children with autism of retired military personnel.
Specifically, this resolution :
1)Makes findings and declarations regarding the increased
incidence of autism and ASD; the unique challenges military
families with children with autism and ASD face; and, the cost
to care for a person with such disorders.
2)States that IBI, including Applied Behavioral Analysis (ABA),
DIR/Floortime, Relationship Development Intervention (RDI),
and other recognized forms of intervention therapy clinically
determined to be effective are making a difference in the
lives of children with ASDs.
3)Makes findings and declarations regarding TRICARE, the health
care management program for military families, implemented by
the Department of Defense (DoD) in 1997 to ensure medical and
mental health care services for families of active duty
military service members;
states that TRICARE has failed to adequately fund IBI services
for children with autism, which impacts services for children
in military families; and, makes findings and declarations
regarding the inadequacy TRICARE's Extended Care Health Option
(ECHO) as it creates barriers to care, enrollment, and
eligibility for IBI services.
4)Respectfully urges the Congress of the United States to fully
fund IBI services through TRICARE for all military families
with children with autism, and include in the legislation a
designation of IBI services as a medical necessity in order to
make coverage of IBI services available for the children with
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autism of retired military personnel.
5)Urges Congress to fully fund all IBI services, including ABA,
DIR/Floortime, RDI, and other forms of intervention therapy
demonstrated to be clinically effective.
6)Directs the Chief Clerk of the Assembly to transmit copies of
this resolution to the President and Vice President of the
United States, the Secretary of Defense, the Speaker of the
House of Representatives, the Majority Leader of the Senate,
Members of the House and Senate Committees on Armed Services,
and to each Senator and Representative from California in the
Congress of the United States.
EXISTING FEDERAL LAW :
1)Requires the Secretary of Defense and his or her designees in
the DoD to administer the nation's military health benefit
plans, referred to as TRICARE.
2)Requires DoD to pay for all medically necessary health care
and mental health care of TRICARE Basic program beneficiaries
without limit.
FISCAL EFFECT : None
COMMENTS :
1)PURPOSE OF THIS RESOLUTION . According to the author, this
resolution is a necessary first step in urging Congress to
fully fund IBI services through TRICARE for all military
families with ASD children. The author states that IBI
services are currently considered "special education" rather
than "health" or "mental health" services and are therefore
not covered under TRICARE. Additionally, the author states
that ECHO, which provides additional coverage for active-duty
military families with children suffering from disabilities
such as ASD, only partially covers IBI services, and is not
available to families of retired military personnel.
Additionally, the author states that this resolution will
encourage Congress to designate all IBI services, such as ABA
DIR/Floortime, and RDI as a medical necessity. According to
the author, the Surgeons General of the Army, Navy, and Marine
Corps along with high level officials in the Air Force and
Coast Guard have all recommended fully funding IBI services
both through TRICARE and through ECHO.
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2)AUTISM SPECTRUM DISORDERS . According to the National
Institute of Neurological Disorders and Stroke, autism is the
most common condition among the group of developmental
disorders known as ASD or pervasive developmental disorders.
ASD also includes Asperger syndrome, Rett syndrome, childhood
disintegrative disorder, and pervasive developmental disorder
not otherwise specified. ASD is characterized by three
distinctive types of behavior. The most common feature of
autism is impaired social interaction, including problems with
verbal and nonverbal communication, lacking empathy, and
failure to understand social cues. The other characteristics
are repetitive behaviors, such as rocking, twirling, and head
banging; and narrow, obsessive interests. These behaviors can
range from mild to disabling. According to the National
Institute of Mental Health (NIMH), approximately two to six
per 1,000 children have ASD, and males are three to four times
more likely to have an ASD than females. NIMH states that
ASDs can often be reliably detected at age three years and in
some cases as early as 18 months. Early diagnosis is
important because, although there is no cure for ASD, evidence
indicates that intensive early intervention in optimal
educational settings for at least two years during the
preschool years results in improved outcomes in most young
children with ASD. There is no single best treatment package
for all children with ASD. Most individuals with ASD respond
best to highly structured, specialized programs.
3)IBI SERVICES . Under the Lanterman Act, which establishes the
regional center system "intensive behavioral intervention" is
defined as any form of ABA that is comprehensive, designed to
address all domains of functioning, and provided in multiple
settings for no more than 40 hours per week, depending on the
individual's needs and progress. Interventions can be
delivered in a one-to-one ratio or small group format, as
appropriate. IBI relies on behavioral techniques such as
unambiguous instruction, shaping through positive
reinforcement of successive approximations, systematic
prompting and fading procedures, discrimination learning, and
careful task analysis. Therapist/tutors providing the service
then assess the impact of each approach for each child, often
weekly, and make adjustments in an effort to individualize the
intervention and maximize the benefits. According to a recent
study in the official Journal of the American Academy of
Pediatrics titled "Randomized, Controlled Trial of an
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Intervention for Toddlers with Autism: The Early Start Denver
Model," children with ASD (ages 18 to 30 months of age) who
received a comprehensive developmental behavioral intervention
showed significant improvements in IQ, adaptive behavior, and
autism diagnosis. Numerous other studies on the effectiveness
of ABA-based intervention in ASD shows that ABA is effective
at developing and improving language and communication skills,
social interactions, daily living skills, and cognitive
functioning.
4)TRICARE AND ECHO . In 1956, Congress created the Civilian
Health and Medical Program of the Uniformed Services (CHAMPUS)
to provide funding for health care services from civilian
providers for uniformed services beneficiaries. The
beneficiaries include dependents of active-duty members,
retirees and their dependents, and dependents of deceased
members. Today, CHAMPUS is implemented through a managed care
program known as TRICARE, which was established in late 1993
by DoD. Under TRICARE, DoD reorganized the military health
care delivery system into 12 new, joint-service regions. DoD
also created a new administrative organization featuring lead
agents in each region to coordinate among the three services
and monitor health care delivery.
According to TRICARE's Web site, the purpose of TRICARE is to
create and maintain high morale in the uniformed services by
providing an improved and uniform program of medical and
dental care for members and certain former members of the
armed services and for their dependents. The package of
benefits available to all military families (including
National Guard and Reserve members), both active duty and
retired, is called TRICARE basic health benefits program.
TRICARE brings together health care resources of the uniformed
services and supplements them with networks of civilian health
care professionals, institutions, pharmacies, and suppliers to
provide access to high-quality health care services while
maintaining the capability to support military operations.
TRICARE serves approximately 9.6 million beneficiaries
worldwide and covers most inpatient and outpatient care that
is medically necessary and considered proven. Congress capped
the liability for health and mental health care of active-duty
families at $1,000 per year and retiree families at $3,000 per
year for the TRICARE basic program. According to DOD, 13,243
of the estimated 1.2 million children of active-duty military
personnel have been diagnosed with ASD.
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In addition to the benefits provided under TRICARE, there are
extended benefits available to the dependents of active duty
members with certain disabilities such as autism through ECHO.
Under ECHO, autistic children of active duty members are
entitled to $36,000 in benefits for certain items and services
not covered under TRICARE, including special education.
Unlike TRICARE Basic, which only covers specified "health" and
"mental health" services, ECHO provides eligible beneficiaries
with coverage for "special education" services, which includes
ABA services.
5)SUPPORT . ACT Today state that while the impacts of autism and
ASD can be devastating for any family, it is particularly
devastating for military families. According to supporters,
children with autism crave routine and familiarity, which is
difficult in a military family where parents are deployed
overseas and often required to relocate. Supporters state
that military families with autistic children in California
face numerous challenges in securing adequate coverage for
necessary and costly services such as ABA, DIR/Floortime, and
RDI. While proper levels of ABA therapy for a child with
autism can cost as much as $100,000 per year, ECHO only covers
up to $36,000 a year for active-duty military families. As a
result, military families are forced to end necessary
treatments or pay thousands of dollars in out-of-pocket costs.
Supporters also cite a recent study by the University of
Washington which demonstrated that children who receive a
combination of these services experience increases in IQ and
changes in behavior. Supporters contend that the Legislature
should support this resolution as it will make clear that
parents of ASD children deserve to have IBI treatment, which
it considers not just an educational service, but a critical
service for military families.
REGISTERED SUPPORT / OPPOSITION :
Support
ACT Today
2 individuals
Opposition
None on file.
AJR 46
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Analysis Prepared by : Martin Radosevich / HEALTH / (916)
319-2097