Rethinking Insurance Coverage of “Experimental” Applied Behavioral Analysis Therapy and Its Usefulness in Combating Autism Spectrum Disorder

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Acknowledgments

*Kendra Hansel is a second-year law student at Southern Illinois University at Carbondale. Address correspondence to Ms. Hansel at Southern Illinois University School of Law, Law Journal Office, 251 Lesar Law Building, Carbondale, Illinois, 62901, or via email at [email protected].

Notes

Michele Trivedi, Living with Autism: Ellie's Story, Autism Soc’y, http://www.autism-society.org/living-with-autism/stories/ellie-trivedi.html (last visited Feb. 25, 2013).

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Family Issues, Autism Soc’y, http://www.autism-society.org/living-with-autism/family-issues/ (last visited Feb. 25, 2013).

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Stress, Autism Soc’y, http://www.autism-society.org/living-with-autism/family-issues/stress.html (last visited Feb. 25, 2013).

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Siblings, Autism Soc’y, http://www.autism-society.org/living-with-autism/family-issues/siblings.html (last visited Feb. 25, 2013).

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Marissa Mazza, Comment, Are You Covered? The Need for Improvement in Insurance Coverage for Autism Spectrum Disorder, 44 J. Marshall L. Rev. 291, 292–93 (2010).

Id.

Id. at 292.

Id.; Combating Autism Act of 2006, Pub. L. No. 109–416, § 2, 120 Stat. 2821, 2821 (2006).

Combatting Autism Act of 2006, 42 U.S.C. § 280i-1 (a)(1)(2006).

42 U.S.C. § 280i-1(b).

Combating Autism Reauthorization Act of 2011, 42 U.S.C. § 280i-1(e) (Supp. V 2011).

Mazza, supra note 18, at 292.

Autism Treatment Acceleration Act, S. 819, 111th Cong. (2009).

Id. § 12.

Id.

Melissa Stuart, Note, Autism Insurance Reform: A Comparison of State Initiatives, 8 Ind. Health L. Rev. 497, 526 (2011).

Mazza, supra note 18, at 292.

Stuart, supra note 29, at 525.

Id.

Id. at 508.

Id.

Mazza, supra note 18, at 291–92.

Walecia Kondra, Dealing with the Financial Burden of Autism, N.Y. Times, Jan. 22, 2010, http://www.nytimes.com/2010/01/23/health/23patient.html?ref=health&_r=0.

Sharona Hoffman, A Proposal for Federal Legislation to Address Health Insurance Coverage for Experimental and Investigational Treatments, 78 Or. L. Rev. 203, 208 (1999).

Id.

Id. at 209.

Id.

Id.

Id. at 209–10.

Joseph B. Clamon, Does My Health Insurance Cover It? Using Evidence-Based Medicine and Binding Arbitration Techniques to Determine What Therapies Fall Under Experimental Exclusion Clauses in Health Insurance Contracts, 54 Drake L. Rev. 473, 481 (2006).

Barbara A. Fisfis, Comment, Who Should Rightfully Decide Whether a Medical Treatment Necessarily Incurred Should Be Excluded from Coverage Under a Health Insurance Policy Provision Which Excludes from Coverage “Experimental” Medical Treatments?, 31 Duq. L. Rev. 777, 780 (1993).

Id. at 781.

Clamon, supra note 43, at 481.

Id.

Id.

Id. at 482.

Id. at 482–83.

Id. at 483.

Id.

Id.

Id. at 484.

Id. at 485.

See State, Dep't of Transp. v. James River Ins. Co., 292 P. 3d 118, 123 (Wash. 2013)(finding a mandatory arbitration agreement invalid because it deprived the court of jurisdiction and violated the rights of policyholders to bring an action against the insurer).

Clamon, supra note 43, at 485.

Id.

Id.

Mazza, supra note 18, at 314.

Id. at 296.

Id. at 297.

Id. at 297–98.

Katherine Kimball, Note, Insuring a Future: Mandating Medical Insurance Coverage of Autism Related Treatments in Nebraska, 42 Creighton L. Rev. 689, 695 (2009); John W. Jacobson et al., Cost-Benefit Estimates for Early Intensive Behavioral Intervention for Young Children with Autism: General Model and Single Case Study, 13 Behav. Interventions 201, 202 (1998).

Kimball, supra note 64, at 696.

Id. at 697.

Id. at 694.

Id.

Id. at 694–95.

Id.

John M. Eisenberg, Therapies for Children with Autism Spectrum Disorders: A Review of the Research for Parents and Caregivers 5 (June 2011), available at http://effectivehealthcare.ahrq.gov/ehc/products/106/709/aut_fin_to_post.pdf.

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Mazza, supra note 18, at 299.

Id.

Id.

Id.

Id.

Id. at 299–300.

Id. at 300.

Id. at 300–01.

Id. at 313.

Eisenberg, supra note 71, at 5.

Id.

Stuart, supra note 29, at 503.

Laura C. Hoffman, Ensuring Access to Health Care for the Autistic Child: More Is Needed than Federal Health Care Reform, 41 Sw. U.L. Rev. 435, 484 (2012).

Kimball, supra note 64, at 722.

Id.

Id. at 722–23.

Id. at 723.

Eisenberg, supra note 71, at 2.

Id. at 10.

Id. at 8.

Id.

Id.

Id.

Id.

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Carol Schall, A Consumer's Guide to Monitoring Psychotropic Medication for Individuals with Autism Spectrum Disorders, 17 Focus on Autism & Other Developmental Disabilities 229, 235 (2002).

Id.

Sharna Olfman, Introduction, in Drugging Our Children: How Profiteers Are Pushing Antipsychotics on Our Youngest, and What We Can Do to Stop It, ix (Sharna Olfman & Brent Dean Robbins eds., 2012).

Id.

Id.

Id. at x.

Milt Freudenheim, Behavior Drugs Lead in Sales for Children, N.Y. Times, May 17, 2004, http://www.nytimes.com/2004/05/17/business/17drug.html?ex=1085815432&ei=1&en=72cd66cf54ffd8d4.

Luke Tsai, Children with Autism Spectrum Disorder: Medicine Today and in the New Millennium, 15 Focus on Autism & Other Devel. Disabilities 138, 138–41 (2000).

Id. at 145.

Mato Topa Augustine, Analysis of the Effects of Psychotropic Medication on the Behavior of Individuals Diagnosed with Autism (Jan. 1, 2010) (unpublished Applied Behavioral Analysis Master's Thesis, Northeastern University)(on file with Bouvé College of Health Sciences), available at http://iris.lib.neu.edu/cgi/viewcontent.cgi?article=1034&context=app_beh_an_theses.

Clamon, supra note 43, at 486.

Id.

Id.

Id. at 487.

Id.

See id.

Emily Smayda, Note, Current Legal Intervention Regarding “Experimental” Treatments Must Be Changed: An Analysis of High Doses of Chemotherapy with Autologous Bone Marrow Transplantation for Breast Cancer Patients, 13 J.L. & Health 257, 266 (1999).

Clamon, supra note 43, at 487.

Id. at 488–90.

See Berge v. United States, 879 F. Supp. 2d 98 (D.D.C. 2012); M.H. v. New York City Dep't of Educ., 685 F.3d 217 (2d Cir. 2012).

Berge, 879 F. Supp. at 135–36.

Id.

See M.H., 685 F.3d at 217.

Id. at 224–25.

Id. at 223.

See id. at 258.

Boyle v. Blue Cross Blue Shield of N.C., 2011 WL 6000786, *1 (E.D. Mich. Nov. 30, 2011); McHenry v. PacificSource Health Plans, 679 F. Supp. 2d 1226, 1228 (D. Or. 2010).

Boyle, 2011 WL at *1.

Id. at *1, *2, *4.

McHenry, 679 F. Supp. 2d at 1228.

Id. at 1235.

Id.

Id. at 1248.

Id. at 1237.

See Hummel v. Ohio Dep't of Job & Family Servs., 844 N.E.2d 360 (Ohio Ct. App. 2005); Parents’ League for Effective Autism Servs. v. Jones-Kelley, 339 F. App’x 542 (6th Cir. 2009); K.G. ex rel. Garrido v. Dudek, 839 F. Supp. 2d 1254 (S.D. Fla. 2011).

Hummel, 844 N.E.2d at 361.

Id.

Id. at 365.

Jones-Kelley, 339 F. App’x at 543–44.

Id.

Id. at 553.

Id. at 548.

Id.

Garrido, 839 F. Supp. 2d at 1257.

Id. at 1259.

Id. at 1265.

Churchill v. CIGNA Corp., 2012 WL 3590691 (E.D. Pa. Aug. 21, 2012).

Id.

Boyle v. Blue Cross Blue Shield of N.C., 2011 WL 6000786, *2 (E.D. Mich. Nov. 30, 2011).

McHenry, 679 F. Supp. 2d at 1234.

Hummel, 844 N.E.2d at 365.

Jones-Kelley, 339 F. App’x at 548.

Dudek, 839 F. Supp. 2d at 1266.

Hoffman, supra note 85, at 473.

See Daniela Caruso, Autism in the U.S.: Social Movement and Legal Change, 36 Am. J.L. & Med. 483 (2010).

See Autism Treatment Acceleration Act of 2009, H.R. 2413, 111th Cong. (2009–2010).

Id.

Hoffman, supra note 85, at 486.

Id. at 475; see also Autism Services and Workforce Acceleration Act of 2011, S. 850, 112th Cong. (2011).

See Hoffman, supra note 85, at 475; S. 850.

Hoffman, supra note 85, at 475.

S. 850, § 5.

Id.

Id.

See Hoffman, supra note 85, at 485–86.

See Melody Harness, Note, What Is “Experimental” Medical Treatment?: A Legislative Definition Is Needed, 44 Clev. St. L. Rev. 67, 95 (1996).

Hoffman, supra note 85, at 477.

Id. at 478–79.

Id. at 480.

Id. at 479.

Angela Barner, Comment, Unlocking Access to Insurance Coverage for Autism Treatment, 6 J.L. Econ. & Pol’y 107, 131 (2009). Autism Speaks is a well-developed organization and has been a leading force for legislative insurance mandates related to ASD. The organization was founded in 2005 and is now a leader in autism science and advocacy. About Us: Autism Speaks History, Autism Speaks, http://www.autismspeaks.org/about-us.

See Model Autism Insurance Legislation, Autism Speaks, http://www.autismspeaks.org/sites/default/files/images/advocacy/AS.ModelAutismInsuranceBill_10.2011.pdf.

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Barner, supra note 168, at 131.

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Id. at 132.

Id. at 133.

See id. at 134.