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State Autism Profiles: Maryland

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DEMOGRAPHICS

In 2000, 2,304 or 2.06% of children ages 3-21 who received special education services in Maryland have autism. In 2014-2015, 10,472 or 10.1% of children with disabilities ages 3-21 who received special education services have autism.

Table 1-1: IDEA Part B - Children with Autism in Maryland for 1999-2000 and 2014-2015
(Child Count by Age Group)

  1999-20002014-2015
Age 3-5

 371

886

Age 6-21

 1,933

9,586

Age 3-21

 2,304

10,472

Source: Reported by the State of Maryland in accordance with Section 618 of IDEA to U.S. Department of Education, Office of Special Education Programs

Table 1-2: IDEA Part B - Children with Disabilities in Maryland for 1999-2000 and 2014-2015
(Child Count by Age Group)

  1999-20002014-2015
Age 3-5

 10,003

13,105

Age 6-11

 48,922

42,444

Age 12-17

48,969 

43,586

Age 18-21

 4,183

5,001

Age 6-21

 102,074

91,031

Age 3-21

 112,077

104,136

Source: Reported by the State of Maryland in accordance with Section 618 of IDEA to U.S. Department of Education, Office of Special Education Programs

STATE TASK FORCE

Autism Task Force
Maryland does not have an active task force on autism at this time. Previously, the Maryland State Department of Education, Division of Special Education/Early Intervention convened a task force in 1998 and delivered a final report, “Service Delivery Recommendations for Young Children with Autism,” on December 10, 2004. The task force was directed to determine existing services and identify the challenges faced with the delivery of those services. The task force was also charged with exploring funding opportunities for autism programs and proposing recommendations to improve Maryland’s autism programs. The findings indicated that children with autism were better served with more interaction and therapy than they were currently receiving. The task force also recommended an increase in training for individuals who diagnose and provide services for treating individuals with autism spectrum disorders. Finally, the task force recommended an increase in funding in order to implement the recommendations.
http://www.bcc-asa.org/AutismTaskForceMemoandReport.pdf

Maryland Commission on Autism
H.B. 503/S.B. 963 was approved by the governor on May 7, 2009, establishing the Maryland Commission on Autism to make recommendations to the Governor, General Assembly, and state agencies about services such as health care and education for individuals with autism spectrum disorders. Among the tasks the commission was charged with completing was a comprehensive statewide plan on an integrated system for the training, treatment, and services for children and adults with autism spectrum disorders. The Commission’s final report, Addressing the Needs of Individuals with Autism Spectrum Disorder in Maryland, was submitted in September 2012.
http://dhmh.maryland.gov/autism/
http://dhmh.maryland.gov/autism/Documents/FINAL_AUTISM_REPORT_10-5-2012.pdf

Task Force to Study an Online Program for Paraprofessionals Assisting Students with Autism
In February 2016, H.B. 1191 was introduced, mandating the formation of a Task Force to study an online program for paraprofessionals assisting students with autism. The task force  was charged to create an overall plan to create a program to provide online training to paraprofessionals who work with students with autism by investigating existing models and analyzing online training methods regarding supporting students with autism.  No further action was taken.

STATE INSURANCE COVERAGE

Maryland requires any health insurers or health maintenance organizations that provide hospital, medical and surgical benefits to individuals or groups shall also provide coverage for habilitative services for children with a congenital or genetic birth defect, which includes autism spectrum disorders and cerebral palsy. Habilitative services covered include occupational therapy, physical therapy, and speech therapy. Health insurers are not required to cover services provided through school or early intervention services. Coverage is provided at a minimum at the same level as other conditions.
(MD Bus Reg Code §15-835)


In 2012, H.B. 1055/S.B. 744 became law requiring the new notice requirements insurers must provide about the coverage of habilitative services. The law also required the creation by the Department of Health and Mental Hygiene of a technical advisory group on the medically necessary and appropriate use of habilitative services to treat autism and autism spectrum disorders. Following a year of hearings, the Maryland Autism Technical Advisory Group in April 2013 recommended new regulations for health insurance coverage for autism treatments, such as applied behavior analysis (ABA). The Maryland Insurance Administration developed a regulatory proposal based on the Advisory Group recommendations.
http://dhmh.maryland.gov/atag/Pages/Home.aspx
http://www.pathfindersforautism.org/docs/Legislation/042513%20ATAG_recommendations_final.pdf

In March 2014, Maryland finalized regulations under the habilitative services mandate as it applied to applied behavior analysis (ABA). The regulations indicate that medically necessary habilitative services for children with autism include behavioral health treatment, including ABA, psychological care and therapeutic care, including speech, physical and occupational therapy. The regulation is clear that ABA may not be denied on the basis that it is experimental or investigational. The regulation does not establish a cap but rather a floor for coverage that carriers cannot deny based solely on the number of hours: less than or equal to 25 hours per week for a child 18 months to 6 years; less than or equal to 10 hours per week for a child from 6 to 19. More hours may be authorized if medically necessary. Only insurance plans regulated by Maryland law – individual plans purchased in Maryland, plans in the Maryland Health Benefits Exchange, and the Maryland State Employee health Plan – are subject to the Maryland Habilitative Services Mandate. Self-insured plans and Medicaid are not covered.
http://www.mdinsurance.state.md.us/sa/docs/documents/consumer/publicnew/parents'-guide-to-habilitative-services.pdf
http://www.pathfindersforautism.org/resources/understanding-insurance/autism-insurance-in-maryland

Since 1994, Maryland has had a comprehensive mental health parity law that ensures insurance coverage for broad based mental health disorders. Mental health benefits are required to be equal to other health benefits, and there is no limit on benefits for psychiatric care annually or over a lifetime.
(MD Bus Reg Code §15-802)

ESSENTIAL HEALTH BENEFITS

Maryland runs its own exchange, and on it, habilitative services are mandated for autism spectrum disorders. The benchmark plan defines habilitative services as “occupational therapy, physical therapy, speech therapy, orthodontics, oral surgery, otologic and audiological therapy.” Applied behavior analysis (ABA) is not included in the mandate or the benchmark plan.
(CareFirst BlueChoice, Inc.; Blue Choice HMO HSA Open Access)

MEDICAID

Maryland Home and Community-Based Services Waiver:Easter Seals Serving DC | MD | VAWaivers for Children w/Autism Spectrum Disorder (Autism Waiver)
In 1998, H.B. 99 was adopted authorizing the Maryland Department of Health and Mental Hygiene (DHMH) to apply for an autism-specific waiver. Approved in 2001, the Autism Waiver provides home and community-based services for children with autism. Children ages 1-to-3 with an individualized family service plan and ages 3 to 21 with an individualized education program who meet an institutional level of care are eligible. Services include respite care, environmental accessibility adaptations, family training, service coordination, supported employment, residential habilitation, intensive individual support services, and therapeutic integration. The waiver remains in effect until June 30, 2019.
http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Waivers/Waivers_faceted.html
http://www.mdlclaw.org/wp-content/uploads/2010/03/Autism-Waiver-Guide-12-04.pdf

Other Waivers
In addition to the autism-specific waiver, Maryland offers two waivers – Community Pathways and New Directions Waivers – for children and adults with developmental disabilities, including autism spectrum disorders who qualify for medical assistance. Individuals must have full eligibility status as determined by DHMH Division of Eligibility Waiver Services. Services include case management, community residential services, community supported living arrangements, respite care, behavioral support, supported employment and adult day habilitation. The waivers are approved through June 30, 2018.
http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Waivers/Waivers.html

EDUCATION

Early Childhood Autism Workgroup
The Maryland State Department of Education convened a workgroup to study young children with autism spectrum disorders and to continue the work of the Autism Task Force.
http://www.autismconnectmd.org/inter/early_child.html

EDUCATION PROGRAMS AND ACTIVITIES

The Autism “Portal” Project
The Autism Portal Project was developed by the Maryland State Department of Education as a tool for parents, educators, and other professionals with an interest in autism to learn more about autism services provided in Maryland and by the department.
http://www.autismconnectmd.org/

OTHER STATE RESOURCES

Licensure of Behavior Analysts
In 2014, the legislature passed S.B. 694 establishing the Behavioral Analyst Advisory Committee within the State Board of Professional Counselors and therapists. The law requires the new Committee to adopt regulations and a code of ethics, set fees for services provided to behavioral analysts, develop licensure requirements for persons to be licensed by the Board as behavior analysts before performing certain work in the state except under certain circumstances, establish education and experience requirements to qualify for a license, establish application fees and requirements for obtaining a license, etc.

Behavioral Analyst Advisory Committee
In 2014, the legislature passed S.B. 694 establishing the Behavioral Analyst Advisory Committee within the State Board of Professional Counselors and therapists. The law requires the new Committee to adopt regulations and a code of ethics, set fees for services provided to behavioral analysts, develop licensure requirements for persons to be licensed by the Board as behavior analysts before performing certain work in the state except under certain circumstances, establish education and experience requirements to qualify for a license, establish application fees and requirements for obtaining a license, etc.
http://dhmh.maryland.gov/bopc/SitePages/Home.aspx

http://dhmh.maryland.gov/bopc/pdfs/faqba.pdf

http://mgaleg.maryland.gov/2014RS/Chapters_noln/CH_328_sb0694e.pdf

Maryland Autism and Developmental Disabilities Monitoring Project
The MD-ADDM is part of a national project funded by the Centers for Disease Control and Prevention. The project is seeking to develop programs to help accurately monitor the number of children with autism is each state. The program is administered at the Johns Hopkins Bloomberg School of Public Health with the assistance of the Maryland State Department of Education.
http://www.jhsph.edu/research/centers-and-institutes/wendy-klag-center-for-autism-and-developmental-disabilities/research-and-projects/monitoring-autism-prevalence.html

Towson University Hussman Center for Adults with Autism
The Hussman Center for Adults with Autism was created in February 2008 to assist individuals with autism spectrum disorders as they transition from school-based services into adulthood, such as employment or advanced educational opportunities. The center provides resources to professionals, individuals with autism spectrum disorders and their families.
http://www.towson.edu/iwb/hussman/

STATE LEGISLATIVE CALENDAR

The Maryland General Assembly meets annually on the second Wednesday in January for 90 calendar days. The 2016 session convened on January 13, 2016 and adjourned on April 11, 2016. The 2017 session is expected to convene on January 11, 2017 and adjourn in April 2017.
http://mlis.state.md.us/

Sponsors of Autism Legislation

  • Sen. Katherine Klausmeier (D-Baltimore Co.) District 8
  • Sen. Richard S. Madaleno, Jr. (D-Montgomery Co.) District 18
  • Sen. Nancy J. King (D-Montgomery Co.) District 39
  • Del. Michael E. Busch (D-Anne Arundel Co.) District 30
  • Del. Nicholaus R. Kipke (R-Anne Arundel Co.) District 31
  • Del. Kirill Reznick (D-Montgomery Co.) District 39
  • Del. Peter A. Hammen (D-Baltimore City) District 46

Prepared by Easterseals, Inc.; November 2016.

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