Welcome!


      WV Autism Insurance Stakeholders
                Roundtable
                           Sponsored by:
TRAIN WV: Training and Resources for Autism Insurance Navigation in WV
                  MAP: Mountaineer Autism Project
                      The Benedum Foundation
    Mountain Lakes Convention and Visitors Bureau of Lewis County.
Introductions

  Sponsors
 Legislators
 Presenters
 Attendees
Our Plan Today
         The goal of this meeting is
                       to
improve access to autism treatment services for
          young children with autism
                      and
   develop collaboration and information
       exchange among all stakeholders.
AGENDA
               8:30-9:00: Registration
               9:00-Morning Session
             Welcome and Introductions
Susannah Poe—Autism, MAP, Legislation, and TRAIN
   Jill McLaury—Overview of the WV Legislation
  Cindy LeGrand and Kathy Shapell—What is ABA?
             WV Highmark Blue Cross
                  The Health Plan
            12:15-1: Lunch at Stillwaters

              1:00: Afternoon Session
Mike Wasmer—Overview on Implementation Issues
  Billy Edwards—Implications of Implementation
               For the ABA Provider.
  Jackie Eckerd—Implications of Implementation
          For Parents and the Community.
      Mike Wasmer—Self-funded Policies and
             Non-Mandated Coverage.
 Group meetings: Insurers, ABA Providers, Parents
           Reports from the Stakeholders
              Planning Our Next Step
What IS Autism?

Autism is a complex neurobiological/ behavioral
disorder characterized by:
    - severe, persistent, and atypical problems in
          social interaction
    - severe, persistent, and atypical problems in
          communication
    - accompanied by unusual or repetitive
          behaviors,
    - occurring before age three.
Autism is…
A broad spectrum of disorders affecting
   – thought
   – perception
   – attention
…not just one disorder with a well-defined set of
 symptoms
 - ranges from mild to severe
 - occurs across all situations
 - is consistently inappropriate for the child’s age
Who Gets Autism?
An equal-opportunity disorder…any financial,
    religious, cultural, geographic group…
                      clusters
         Boys more likely than girls
               1 in 88 in US
            Incidence is Rising
Autism is an Epidemic
It is the fastest growing serious
  developmental disability in the US
  ---More common than pediatric cancers, diabetes,
    and AIDS combined.
  ---CDC calls rise in autism an ―epidemic‖ that
    can’t be explained by improved diagnostic
    criteria, ―transfer of labels,‖ or earlier exposure
    to younger children.
What we know about autism…
Early identification and referral to high quality, intensive
   treatment is critical for improving outcomes
Between ages of 2 and 6 are the critical times for learning and
   ―recovering‖
Research concludes that effective treatment is possible using
   the methods of ABA...any treatment other than intensive,
   1:1, individualized has no scientific evidence to support its
   use—
Children with autism have more
medical needs than typically-developing
children but are usually excluded from
the same benefits due to the autism
diagnosis
ABA: Autism’s
Evidence-Based Treatment
Stonewall ppt
The beginning…
      Many years of effort paved the way
   In 2007, first WV autism insurance bill
            introduced in Legislature
2010 – Philadelphia Meeting, MAP was formed
         2011– One Voice Campaign
                Sunrise Process
              2012– Clean Up Bill
WVUCED identified/invited state leaders
The state team participated in facilitated discussions to develop
  a plan and actionable priorities to bring home to improve
   WV’s system to identify, assess, and serve young children
                           with autism.
Region III
            Act Early Conference
Conference sponsored by:
National Center for Birth Defects and Developmental
  Disabilities, CDC, and MCH at Health Resources and
  Services Administration (HRSA), facilitated by AUCDD
Goal: enhance identification, assessment, service
  coordination and provision of services for children with
  ASD and related DD
  1 ½ days to share, discuss, learn
  Sharing best practices opportunities, challenges with
  peers from other states in the region
Impact Statement:
 To develop a seamless, collaborative,
comprehensive plan for screening, early
identification, assessment/diagnosis and
family-centered services that meets the
      needs of our state’s citizens.



 MAP was born.
First step:
         Asked to Present ―Gaps in Services‖ to
             Senate Judiciary Committee

• Not enough well-trained diagnosticians able/willing
  to provide early identification
• Few in-state resources to provide evidence-based
  treatment
• Lack of financial supports for all families with special
  needs
• Existing services do not or can not reach all families
• Life span specialists generally unavailable in state
Question: What Was Needed:
                       Quicker Diagnosis
      More Intensive, Available, Evidence-Based Treatment:
Less than 2 % of WV Children Received ANY Evidence-Based tx
                    More Trained Providers

                       Answer:
 Financial resources for treatment of this MEDICAL condition
         Better outcomes for children and families—
                         And all of WV
                   Increase in employment
               Market for Trained Professionals
MAP’s Commitment:
      Passing Insurance Legislation and
    Increasing Community Resources and
              Access to Services

•   With One Voice
•   Parent Involvement
•   Education and Awareness
•   Increase understanding that ABA is the most
    recommended, mature, proven, medically-directed
    treatment for autism
In 2011, One Voice
Flash Mob
Cupcakes
Walk A Mile
In Our Shoes
Trail Mix
Presentations
West Virginia Became 25th
State to Mandate Autism Insurance
Not Over Yet…2012
   Board of Examiners Challenge led to
           Sunrise Application
Incorrect Wording of the Passed Legislation
  Led to Reintroduction of Corrected Bill



                        Passed. Signed.
On To Next MAP Goal:

    Increase Awareness and Access
                   via
TRAIN: Training and Resources for Autism
       Insurance Navigation in WV
 Grant Funded by Benedum Foundation
         and in partnership with
     Mountaineer Autism Project
TRAIN WV

         Bring Together Stakeholders
       Develop Information Exchange
   Provide Access Information for Families
   Provide Billing Information for BCBA’s
Provide Tx Resources for Insurance Companies
   Offer Demonstration Treatment Center
        Outreach and Resource Center
And That’s Why We’re Here!

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Stonewall ppt

  • 1. Welcome! WV Autism Insurance Stakeholders Roundtable Sponsored by: TRAIN WV: Training and Resources for Autism Insurance Navigation in WV MAP: Mountaineer Autism Project The Benedum Foundation Mountain Lakes Convention and Visitors Bureau of Lewis County.
  • 2. Introductions Sponsors Legislators Presenters Attendees
  • 3. Our Plan Today The goal of this meeting is to improve access to autism treatment services for young children with autism and develop collaboration and information exchange among all stakeholders.
  • 4. AGENDA 8:30-9:00: Registration 9:00-Morning Session Welcome and Introductions Susannah Poe—Autism, MAP, Legislation, and TRAIN Jill McLaury—Overview of the WV Legislation Cindy LeGrand and Kathy Shapell—What is ABA? WV Highmark Blue Cross The Health Plan 12:15-1: Lunch at Stillwaters 1:00: Afternoon Session Mike Wasmer—Overview on Implementation Issues Billy Edwards—Implications of Implementation For the ABA Provider. Jackie Eckerd—Implications of Implementation For Parents and the Community. Mike Wasmer—Self-funded Policies and Non-Mandated Coverage. Group meetings: Insurers, ABA Providers, Parents Reports from the Stakeholders Planning Our Next Step
  • 5. What IS Autism? Autism is a complex neurobiological/ behavioral disorder characterized by: - severe, persistent, and atypical problems in social interaction - severe, persistent, and atypical problems in communication - accompanied by unusual or repetitive behaviors, - occurring before age three.
  • 6. Autism is… A broad spectrum of disorders affecting – thought – perception – attention …not just one disorder with a well-defined set of symptoms - ranges from mild to severe - occurs across all situations - is consistently inappropriate for the child’s age
  • 7. Who Gets Autism? An equal-opportunity disorder…any financial, religious, cultural, geographic group… clusters Boys more likely than girls 1 in 88 in US Incidence is Rising
  • 8. Autism is an Epidemic It is the fastest growing serious developmental disability in the US ---More common than pediatric cancers, diabetes, and AIDS combined. ---CDC calls rise in autism an ―epidemic‖ that can’t be explained by improved diagnostic criteria, ―transfer of labels,‖ or earlier exposure to younger children.
  • 9. What we know about autism… Early identification and referral to high quality, intensive treatment is critical for improving outcomes Between ages of 2 and 6 are the critical times for learning and ―recovering‖ Research concludes that effective treatment is possible using the methods of ABA...any treatment other than intensive, 1:1, individualized has no scientific evidence to support its use— Children with autism have more medical needs than typically-developing children but are usually excluded from the same benefits due to the autism diagnosis
  • 12. The beginning… Many years of effort paved the way In 2007, first WV autism insurance bill introduced in Legislature 2010 – Philadelphia Meeting, MAP was formed 2011– One Voice Campaign Sunrise Process 2012– Clean Up Bill
  • 13. WVUCED identified/invited state leaders The state team participated in facilitated discussions to develop a plan and actionable priorities to bring home to improve WV’s system to identify, assess, and serve young children with autism.
  • 14. Region III Act Early Conference Conference sponsored by: National Center for Birth Defects and Developmental Disabilities, CDC, and MCH at Health Resources and Services Administration (HRSA), facilitated by AUCDD Goal: enhance identification, assessment, service coordination and provision of services for children with ASD and related DD 1 ½ days to share, discuss, learn Sharing best practices opportunities, challenges with peers from other states in the region
  • 15. Impact Statement: To develop a seamless, collaborative, comprehensive plan for screening, early identification, assessment/diagnosis and family-centered services that meets the needs of our state’s citizens. MAP was born.
  • 16. First step: Asked to Present ―Gaps in Services‖ to Senate Judiciary Committee • Not enough well-trained diagnosticians able/willing to provide early identification • Few in-state resources to provide evidence-based treatment • Lack of financial supports for all families with special needs • Existing services do not or can not reach all families • Life span specialists generally unavailable in state
  • 17. Question: What Was Needed: Quicker Diagnosis More Intensive, Available, Evidence-Based Treatment: Less than 2 % of WV Children Received ANY Evidence-Based tx More Trained Providers Answer: Financial resources for treatment of this MEDICAL condition Better outcomes for children and families— And all of WV Increase in employment Market for Trained Professionals
  • 18. MAP’s Commitment: Passing Insurance Legislation and Increasing Community Resources and Access to Services • With One Voice • Parent Involvement • Education and Awareness • Increase understanding that ABA is the most recommended, mature, proven, medically-directed treatment for autism
  • 19. In 2011, One Voice Flash Mob Cupcakes Walk A Mile In Our Shoes Trail Mix Presentations
  • 20. West Virginia Became 25th State to Mandate Autism Insurance
  • 21. Not Over Yet…2012 Board of Examiners Challenge led to Sunrise Application Incorrect Wording of the Passed Legislation Led to Reintroduction of Corrected Bill Passed. Signed.
  • 22. On To Next MAP Goal: Increase Awareness and Access via TRAIN: Training and Resources for Autism Insurance Navigation in WV Grant Funded by Benedum Foundation and in partnership with Mountaineer Autism Project
  • 23. TRAIN WV Bring Together Stakeholders Develop Information Exchange Provide Access Information for Families Provide Billing Information for BCBA’s Provide Tx Resources for Insurance Companies Offer Demonstration Treatment Center Outreach and Resource Center
  • 24. And That’s Why We’re Here!

Editor's Notes

  • #3: Mr. Francis Cogar  Board member of The Mountain Lakes Convention and Visitors Bureau of Lewis County will be saying welcome and passing out information about the area to our guests.      About 5 minutes We also want to thank Mr J or "J"  as they call him at Plantation Inn and Suites.