Author Archives: nebraska


Judge: State must cover medically necessary autism services

Link to the Journal Star Story

Nebraska must pay for autism services — and any other treatments deemed medically necessary — for the state’s Medicaid-eligible children, a Lancaster County judge has ruled.

In a 19-page order filed Tuesday, District Judge John Colborn found a state Department of Health and Human Services policy that excluded Medicaid coverage of Applied Behavior Analysis services, often prescribed to treat development disabilities like autism, violated federal law.

The judge also agreed to certify the case as a class action, meaning his order applies to all children in similar situations in Nebraska. And he also ordered the state to stop enforcing its unlawful policy.

A day later, the Nebraska Appleseed Center, which filed the suit on behalf of two unnamed boys now 6 and 7, hailed the decision as a big win.

“This ruling is an important victory for Nebraska families with children who have been wrongfully denied access to essential mental and behavioral health treatments that were recommended by their doctors,” said Appleseed legal director Sarah Helvey. “The court’s ruling will allow more children to get the care they need to have the best possible future.”

Asked how HHS would move forward as a result of the ruling, spokeswoman Kathie Osterman said: “I can tell you that we’re reviewing the decision and working with the Attorney General’s Office to determine our next steps.”

The state has 30 days to decide if it wants to appeal.

Helvey said Nebraska Appleseed is looking forward to working with the department “to begin covering these vital treatments immediately for the hundreds of Nebraska children who need them.”

She believes Medicaid-eligible children should be able to get the treatments immediately.

It’s been a long time coming, Helvey said.

In 2012, working with the National Health Law Program and Husch Blackwell LLP, the Nebraska Appleseed Center filed the lawsuit on behalf of the two Nebraska boys against then-HHS director Kerry Winterer and Vivianne Chaumont, then director of the Division of Medicaid and Long-Term Care.

At the time, one was a 4-year-old diagnosed with disruptive behavior disorder, autism spectrum disorder and attention deficit hyperactivity disorder, among other issues.

The other was a 3-year-old diagnosed with Pica, an eating disorder, and stereotypic movement disorder, characteristic of repetitive, purposeless movements that can cause bodily harm.

Doctors for both boys, who are from separate families and both eligible for Medicaid, had recommended treatment that included Applied Behavior Analysis services.

But Magellan Health Services, a contractor that reviews requests for mental and behavioral health treatments for Medicaid-eligible children, denied the treatments based on HHS policy.

The policy categorically excludes Medicaid coverage for Applied Behavior Analysis services and behavior modification management.

Neither of the boys got the treatment that Nebraska Appleseed staff attorney Robert McEwen said has been shown to prevent the further progression of self-injury for developmentally disabled kids and, if provided at an early enough age, can put them back on the developmental track where they started.

“It’s been a long haul for them,” McEwen said of the boys and their families, with whom he talked on Tuesday. “It was a really happy conversation.”

He said the judge was clear about coverage of services for children under Medicaid: If a service can be covered and is allowed under Medicaid, it must be covered by the state when it’s deemed medically necessary.

Moving forward, McEwen said, the decision not only will help ensure Medicaid-eligible kids in Nebraska get Applied Behavior Analysis services but also other treatments deemed medically necessary.

He called it a big step forward for Nebraska children.


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KMTV interviews ASN: Republican debate’s spotlight on autism helps raise awareness

Republican debate’s spotlight on autism helps raise awareness

Watch HERE

By Miranda Christian.

OMAHA, Neb. (KMTV) – Republican candidate Donald Trump highlighted the autism and vaccine issue at the Republican debate Wednesday night. Trump suggested that vaccines can cause autism.

Coincidentally, the next day was “The Big Give for Autism” fundraiser, held by the Autism Society of America.

The Nebraska chapter’s vice president Wendy Hamilton said that when the topic of autism appears in the national spotlight, they try to look at the positive side.

“Any publicity is good publicity. I would hope that with the conversation being made so public, people take an opportunity to say, ‘Wait a second, I think I want to look into that a little bit more,’” said Hamilton.

The vaccine debate has been around for years and Trump is bringing it back to the forefront.

“I am not here to tell people what to believe or not to believe, except educate yourself,” said Hamilton

Autism being discussed during the debate could not have come at a better time for ASA. A national all-day, online fundraiser would take place Thursday. The money raised will help the 21,000 Nebraskans who are diagnosed with autism.

“I think anytime it is brought up in conversation is good, the timing couldn’t have been more perfect for us giving we are doing a major fundraiser, so for that, we say thanks,” said Hamilton.


North Platte Autism Safety Training

Two exciting training opportunities are offered by the Autism Society of Nebraska – North Platte Support Network.

Family, School, & Community  (download flyer for this session HERE)

Date: Tuesday, October 13, 2015
Time: 6:30 p.m. – 8:30 p.m.
Location: Holiday Inn Express and Suites
Instructors: Sgt. Scott Schuelke (Ret. Lansing Police Department),
300 Holiday Frontage Rd., North Platte, NE 69101 (I-80 & Hwy 83)
Autism Safety Specialist, Autism Alliance of Michigan

Police, Fire, and EMS  (download flyer for this session HERE)

Session 1: Tuesday, October 13, 2015, 9:00 a.m. – 11:00 a.m.
Session 2: Wednesday, October 14, 2015, 6:30 p.m. – 8:30 p.m.
Location: Holiday Inn Express and Suites 300 Holiday Frontage Rd, North Platte, NE 69101
Instructor: Sgt. Scott Schuelke (Ret. Lansing Police Department), Autism Safety Specialist, Autism Alliance of Michigan

The Big Give for Autism

Join The Big Give for Autism

September 17, 2015

Join The Big Give for Autism


Help Improve Lives Affected by Autism

Big Give for Autism Society of Nebraska

As the nation’s oldest and largest grassroots organization founded to help all affected by autism, the Autism Society is IN communities, working FOR communities and collaborating WITH communities to make life better for those with autism.

For Fifty years the Autism Society has provided support to people on the autism spectrum, their families, caregivers, friends and loved ones.  Consider how life with autism looked before the Autism Society was founded:

  • Approximately one in four young adults with autism was socially isolated.
  • Four in every 10 young adults on the autism spectrum never worked for pay between high school and their early 20s. Those who got jobs tended to work part-time in low-wage jobs.
  • Approximately 26% of young adults on the autism spectrum received no services – services which could help them become employed, continue their education or live more independently.
  • Over half of young adults with autism received no vocational or life skills services during their early 20s.
  • Nearly 37% of young adults with autism were disconnected from both work and education after high school.
Through over 100 local affiliates, and with the help of partnering organizations, the Autism Society is uniquely positioned to reach a nationwide audience giving all those affected by autism an equal voice in things that impact their lives.

Right now you can stand with the Autism Society by getting involved in The Big Give for Autism– our biggest one-day giving campaign ever – using the hashtag #AutismBigGive.
When you support The Big Give for Autism (#AutismBigGive) you allow the Autism Society to:

  • Promote early identification and access to effective treatments for preschool children helping to reduce lifetime care costs by two-thirds.
  • Help parents, teachers, and caregivers build education and treatment programs, so that all children and adolescents can leave school prepared to reach their fullest potential.
  • Ensure that every young adult or post-graduate with autism has access to services and supports that maximize independence and secure the highest quality of life.
But that’s only the beginning.  Your support also enables the Autism Society to take steps to best meet the increasing needs of the growing autism community.
Currently, there are an estimated 3.5 million people in the United States living with Autism Spectrum Disorder (ASD). With your support we can address the day-to-day issues faced by people on the spectrum, advocate for appropriate services for individuals with ASD, and provide the latest information regarding treatment, education, research and advocacy.
The Autism Society has a proud history and an even brighter future…but only if we all work together.  

Nebraska won’t appeal ruling expanding autism coverage under Medicaid

By Martha Stoddard / World-Herald bureau

LINCOLN — Nebraska won’t fight a judge’s order for Medicaid to start covering a potentially costly but effective treatment for children with autism.


Calder Lynch, the state Medicaid director, said Wednesday that the state would not appeal the June ruling. He wants to have all the pieces in place so Medicaid can start paying for applied behavior analysis and similar treatments by the end of the year.


“I think it’s a good service, and I’m glad that we’ve been able to move forward to provide it,” Lynch said.


The state’s decision represents a long-sought victory for parents of autistic children and their advocates.


In the past, Nebraska officials have resisted efforts to add coverage for the treatment, citing concerns about potential costs.


Lynch said the change in the state’s position stems from several factors, including a directive from the federal government and changes in what professionals consider best practices in autism treatment.


“Given the judge’s ruling and how we’ve seen this issue evolve, it didn’t make sense to continue the appeal process,” he said.


Lancaster County District Judge John Colborn issued the ruling June 30 in a class-action lawsuit.


The suit was filed in 2012 by the Nebraska Appleseed Center for Law in the Public Interest and the National Health Law Program on behalf of two boys, identified only as K.D. and S.L.


Robert McEwen, an attorney for the boys, said he was pleased that the state would not appeal.


“We now look forward to swift and complete implementation of the court’s decision so that children with serious behavioral needs can get the important services they need,” he said.


In his ruling, Colborn ordered Medicaid to start paying for applied behavior analysis and similar treatments for children if recommended by medical professionals.


Applied behavior analysis uses positive reinforcement and other techniques to change behavior. It can eliminate symptoms of autism for some children and dramatically reduce the symptoms in others. But depending on a child’s needs, it can be very intensive and expensive.


Previously Nebraska Medicaid barred coverage of behavior modification services, including applied behavior analysis. The program also prohibited coverage of mental health treatments when aimed at treating developmental disabilities.


In his order, Colborn found that the prohibitions violate federal law.


Lynch said it would take some time to implement the change, starting with developing a plan and getting court approval of the plan.


The process also involves getting federal approval, rewriting state regulations, contracting with providers and developing payment rates.


Lynch said it is too early to calculate the cost of covering the treatment.


The boys named in the lawsuit had both been denied coverage of applied behavior analysis, though their doctors had recommended the treatment to help them function better.


K.D., now 7, has been diagnosed with autism, among other conditions.


According to the petition, his behavior includes screaming, twirling, throwing tantrums, pinching, biting and banging his head.


A psychologist recommended applied behavior analysis to help him learn to follow directions, talk more, tolerate frustration better, and reduce aggression and tantrums.


S.L., now 6, has severe behavioral disorders, including running away, eating objects such as sponges and toys, slapping and biting himself, hitting others, destroying property, and licking electrical sockets.


A psychologist recommended applied behavior analysis to curb his aggression and self-injuring behavior, as well as to prolong his life and reduce his disabilities.


State officials last year estimated that 2,305 children in the Medicaid program may need the treatment. About 30 percent of Nebraska children have health coverage through Medicaid.


In Missouri, a study found that health insurance claims for applied behavior analysis treatment averaged $1,704 annually in 2013. However, the treatment can cost as much as $50,000 a year for some children.


Advocates argued that the treatment can reduce future costs by making autism less disabling or by helping people overcome it altogether.


Last year, Nebraska lawmakers mandated that some private health insurance plans cover autism diagnosis and treatment for children, including applied behavior analysis.


The new law, which applied to policies taking effect this year, was expected to benefit about 1,000 Nebraska children.


The law does not apply to self-funded insurance policies, which cover about 60 percent of Nebraskans and are regulated by federal law. The law also does not apply to most individual or small-group policies. Including those policies would have triggered a provision in the federal Affordable Care Act that requires states to pay for insurance mandates exceeding what the federal law requires.



Click to see story here


Nebraska Appleseed Court Victory

Court victory allows Children access to Vital Behavioral Health Treatments

Lancaster County District Court sides with Appleseed in important decision

LINCOLN — Yesterday, Lancaster County District Court Judge John Colborn issued an order protecting the rights of Nebraska children with autism and developmental disabilities to get vitally important behavioral health treatments through the Medicaid program.

The case, K.D. & S.L. v. Winterer, was filed on behalf of two Nebraska children who each have serious behavioral and mental health conditions, but had been denied coverage for necessary treatments recommended by their doctors.  The suit challenged a Nebraska Department of Health and Human Services’ (HHS) policy that excludes Medicaid coverage of certain treatments for children with developmental disabilities.  Yesterday’s decision granted the plaintiff children’s motions for class certification and summary judgment.  As a result of the judge’s order, HHS can no longer enforce these policies which have been determined by the court to be unlawful.  Part of the judge’s ruling was to certify the case as a class action, meaning the ruling applies to all children in a similar situation as the named plaintiffs.

“This ruling is an important victory for Nebraska families with children who have been wrongfully denied access to essential mental and behavioral health treatments that were recommended by their doctors,” said Sarah Helvey, Nebraska Appleseed Legal Director. “The Court’s ruling will allow more children to get the care they need to have the best possible future.

“Now that this order is in effect, we look forward to working with the Department to begin covering these vital treatments immediately for the hundreds of Nebraska children who need them.”

The children in this case were represented by Nebraska Appleseed, the National Health Law Program, and Husch Blackwell LLP.

Read more here:

AutismSociety_50th_Anniversay_Logo_Full_Color (1)

Autism Society National Conference

National Conference

Since 1965, the Autism Society has embraced its mission to make a better world for all with autism. Shortly after its founding, the Autism Society held an inaugural national conference to discuss the state of children with ASD in America. This meeting brought together parents of children with ASD to share resources, experiences and develop strategies to be effective advocates for their children

Today, the Autism Society’s annual conference represents one of the largest gathering of autism families, service providers, educators, policymakers and key allies in the disability community. Each year, the Autism Society’s annual conference and exposition features a keynote presentation, close to 100 breakout sessions, a conference exhibit hall with autism resources and networking opportunities with conference attendees from around the nation. Here you will find a comprehensive guide to the Autism Society National Conference.

46th Annual Autism Society National Conference
July 8 – 11, 2015

Register Today