Law Signed by Governor Quinn in April Helps Kids in Illinois with Stroke/Heart Defects

Governor Signs Coulson Bill to Mandate Coverage of Habilitative Services for Children with Genetic Defects

Last month, Governor Pat Quinn signed into law legislation championed by State Representative Coulson and State Senator Crotty that will ensure children who need habilitative services due to a trauma or injury at a young age or a congenital or genetic birth defect have health care coverage.

Specifically, Senate Bill 101 mandates insurance companies to provide coverage for occupational therapy, physical therapy and speech therapy for children under the age of 19 with congenital or genetic defects that developed at birth or at a young age. The legislation passed in the House and Senate unanimously. Senate Bill 101 from the 95th General Assembly requires insurance companies to cover these medically necessary therapies for children born with conditions such as autism, cerebral palsy, down syndrome and other neurological conditions.

Senator M. Maggie Crotty and Representative Beth Coulson championed the legislation so insurance claims would no longer be denied because the therapy was “habilitative” in nature. Some insurance companies were approving coverage to help a child recover previously acquired skills lost because of injury or illness since the therapy was rehabilitative in nature. However, in many cases, denials were given forcare (and called “habilitative” in nature) if the child had not previously developed basic skills such as walking or talking.

“The system was confusing and discriminatory to families,” Sen. Crotty explained. “In recent years, insurance companies have denied these critical therapies for some children, while turning down coverage for others. This law rectifies inconsistent coverage for kids who have been punished for no good reason. In these tough economic times, we are pleased to take just one major expense off the backs of hard-working families who are trying to give their kids basic skills to help them reach their true potential.”

“As a physical therapist, I have personally witnessed the amazing recovery of children who have access tohabilitative services. Many children who receive habilitative services demonstrate tremendousimprovement and progress. Covering the costs of these services has the potential to improve a child’soverall development and quality of life,” Rep. Coulson said. State programs in Illinois already provide habilitative care to most Medicaid patients, but there was no requirement for private insurers to do so. Pediatricians have long been frustrated when trying to obtain habilitative care for their patients with private insurance. Families with children needing medically indicated,available therapies to acquire basic skills have had to pay for the services themselves or forgothem. This sacrifices a window of opportunity to enhance a child’s functioning in daily life activities.

Health care providers and families know that suboptimal intervention early in life not only impacts how a child performs in the short-term but can have detrimental effects on long-term outcomes. “This law will go a long way toward the goal of each child in Illinois receiving the therapies they need to achieve their truepotential,” said Dr. Ed Pont, Past-President of the Illinois Chapter of the American Academy of Pediatrics(AAP).Alan Rosenblatt, MD, FAAP, a neurodevelopmental pediatrician, used his experience working on aMaryland law to push for similar reform in Illinois.

“I knew from the Maryland bill that we could affectthe care of children with a wide range of conditions, from cerebral palsy and other motor disorders tolanguage and cognitive disabilities to those with sensory impairments and genetic conditions,” Dr.Rosenblatt said. Analysis of the economic impact of the Maryland habilitative care law showed that the cost of that mandate was less than 0.1% of the average annual insurance premium. Habilitative carelegislation as encompassing as that in Illinois and Maryland exists only in the District of Columbia, which passed a similar measure in 2006.

“We need this type of legislation to ensure coverage of the unique and important therapies children withcongenital, genetic or early acquired disorders require,” Dr. Rosenblatt said. “This will help children withautism and countless other delays and disorders maximize their true potential.”

“I am absolutely thrilled to be able to call the families in my district and let them know that they can now receive the help they need. I will continue to fight for children with disabilities – to help ease their hardships and make certain that they have access to the very best health care programs,” Rep. Coulson said.

If you or someone you know has a child who has had a stroke or suffers from another defect that requires these therapies and you want more information, the following resources/organizations can help!:

Contact Rep.Coulson
Springfield Office:
220-N Stratton Office Building
Springfield, IL 62706
(217) 782-4194
(217) 782-7613 FAX

District Office:
3801 West Lake Avenue
Glenview, IL 60026
(847) 724-3233
(847) 724-8682 FAX
Cook County

Contact Senator Crotty

Springfield Office:
Senator 19th District
122 Capitol Building
Springfield, IL 62706
(217) 782-9595

District Office:
5119 West 159th Street
1st Floor East
Oak Forest, IL 60452
(708) 687-9696
(708) 687-9801 FAX

Contact SSEEO! (Stroke Survivors Empowering Each Other) , http://www.sseeo.org/

Contact Health and Disability Advocates, http://www.hdaadvocates.org/