Arizona Advocates Preparing for Autism Insurance Push; Group Publishes Autism Speaks Report on Coverage Costs, Benefits

Arizona advocates for health insurance coverage for autism services are planning to hold a rally Tuesday, January 29, 2008, at 6 p.m. in front of the state Capitol building in Phoenix. The event is part of a campaign to get insurance coverage for autism services in the state for children and young adults under age 21.

Advocates have set up a website, AZAutismInsurance.org, as a home page for news and information about the effort. In addition to keeping Arizona advocates up to date, the group's website hosts an important document that advocates around the country could find useful.

The 23-page document, "Arguments in Support of Private Insurance Coverage of Autism-Related Services," prepared by the national advocacy group Autism Speaks in October, lays out in clear language eight reasons why a state like Arizona should pass laws that mandate insurance coverage of autism services.

The report includes cost estimates based on studies in other states—a few dollars a month added to the average health insurance policy—and benefits: access to services now out of reach of many affected children. The report explains how existing services and government programs, including Medicaid, fall short of what's needed for a growing population of those diagnosed with autism spectrum disorders. And it brings up an argument heard before: it pays to provide services to children, to help them grow and develop, so that it costs less to provide supports later in life.

The following is a rundown of the arguments, excerpted from the beginning of the report:

Argument 1: Mandated private health insurance coverage will provide services that are desperately needed by children with autism, who have greater health care needs than children without autism.

Argument 2: Treatments for autism are difficult to access, often inadequate, and frequently delayed. Denied coverage by private group health insurance companies, parents are often forced either to pay out-of-pocket or forego the treatments their children need.

Argument 3: Mandated private insurance coverage will bring effective autism services within the reach of children who need them. The efficacy of Applied Behavior Analysis (ABA), the centerpiece of this legislative mandate’s benefits, has been established repeatedly.

Argument 4: Government and scientific organizations have endorsed Applied Behavior Analysis (ABA) and other structured behavioral therapies.

Argument 5: To combat the difficulty many families face in accessing Applied Behavior Analysis (ABA) and other structured behavioral treatments through public insurance, three states have passed autism insurance mandates that specifically require private insurance companies to provide coverage of these therapies, thus creating a public-private partnership for the provision of care.

Argument 6: The costs of this insurance reform are small and will have very little impact on the cost of health insurance premiums for the individual consumer.

Argument 7: By improving outcomes for children with autism, mandated private insurance coverage will decrease the lifetime costs of treating and providing services and will actually result in an overall cost savings in the long-run.

Argument 8: Without passage of legislation requiring private health insurance coverage for autism, the costs associated with autism will continue not only to affect families, but will have far reaching social effects as well.

It will be interesting to see how the discussion plays out in Phoenix. A cursory check of the Arizona State Legislature's website indicates that there are no current bills filed relating to autism yet; I will look to update readers when I learn more information.

Also see from Autism Bulletin's archives:

* Michigan to Hold Hearing on Autism Insurance Legislation

* Articles related to health insurance

Michigan to Hold Hearing on Autism Insurance Legislation

Michigan State Rep. Kathy Angerer, a Democrat from Dundee who chairs the House Health Policy Committee, has filed two bills that would require health insurance companies to cover diagnosis and treatment for autism spectrum disorders. Angerer's House panel is scheduled to hold a hearing on the measures, Dec. 13 at 9 a.m. in Room 519 of the House Office Building in Lansing. Thanks to the bloggers at Autism Insurance in Michigan for passing along word of this hearing and links to the legislation.

The wording of the legislation is below; what's interesting to note is the specific items covered—speech, OT, ABA, PT and early intervention services. The bill does not mention age restrictions as in states like South Carolina and Texas.

"More and more children across our state are being diagnosed with autism, leaving an increasing number of Michigan families struggling to keep up with the high costs of treatment," Angerer said in a statement. "Proper screening and treatment of autism is crucial to a child's development, and experts agree that early diagnosis and treatment is vital to increasing the chances that a child will reach their full potential. Excluding autism from coverage is not only arbitrary and unfair – it sets back efforts to understand and treat this disorder, which threatens to increase health care costs for everyone down the road."

Angerer is the lead sponsor of two house bills, No. 5529 and No. 5527, each of which calls for coverage of autism-related services. The bills have parallel Senate versions (Nos. 784 and 785) sponsored by Sen. Tupac Hunter, a Detroit Democrat (again, noted by Autism Insurance in Michigan.)

Language in the Michigan Bills

Here's specifics on what the House bills cover. Bill No. 5529 states that authorized hospitals, medical facilities, health maintenance plans:

shall provide coverage for the treatment of autism spectrum disorder, including, but not limited to, coverage for therapeutic evaluations and interventions, speech therapy, intensive early intervention, applied behavioral analysis, and Lovaas behavioral therapy.

Coverage for autism spectrum disorder under this section is subject to the same terms and conditions that the insurer or health maintenance organization applies to the treatment of other disorders. However, an insurer or health maintenance organization may confirm a diagnosis or review the appropriateness of a specific treatment plan in order to insure that coverage under this section is limited to diagnostic and treatment services.

As used in this section, "autism spectrum disorder" means a neurobiological condition that includes autism Asperger Syndrome and Rett's Syndrome.

The other bill, No. 5527 has the exact same wording regarding coverage of services, and what autism means, except it applies to "a health care corporation group or nongroup"; in other words, other kinds of health insurance organizations and health care organizations.

Also see in Autism Bulletin archives:

* Past coverage of health insurance

Also, an updated version of the Autism Insurance Map is below (e-mail subscribers, click here if you have trouble seeing it):

Colorado Family Wins Insurance for Autism Services

An arbitrator in a Colorado family's dispute over whether Applied Behavior Analysis (ABA) therapy is covered under a health insurance plan has ruled in favor of the family seeking reimbursement for about $110,000 over two years of therapy.

Autism services advocates are hailing the decision in the case of Jill and Stephen Tappert who appealed several coverage denials for ABA services for their young daughter Abby by Anthem Blue Cross Blue Shield of Denver, as an important victory.

But a spokeswoman for Anthem told Denver ABC TV affiliate KMGH Channel 7 the insurance company believed Tappert case was a single instance and was not precedent-setting: "This decision is not a broad-based declaration that ABA therapy is 'medically necessary' in all cases. To what extent this type of therapy should be covered...should be made by legislators and/or the division of insurance."

It's not surprising for the insurer to assert a narrow reading of the case. However, families around the country could study the arbitrator's decision which clearly states that ABA is a mainstream, research-based approach for early intervention services for young children with an autism spectrum disorder diagnosis—and rejecting the insurer's arguments that it's not an effective medical treatment.

The case also raises questions for other insurance companies and whether they could use this decision to revise their coverage policies or the administrative rules that govern them.

One thing the Anthem spokeswoman hit upon was a legislative trend. The question about health insurance coverage for autism services such as ABA has, in fact, been a theme of legislative debates around the country as the issue makes its way through state-level debates. Reading different bills, some legislators leave the wording vague as to what health insurers should cover; new laws have passed in South Carolina, which calls for coverage of behavioral therapy, and Texas which calls for coverage of ABA. (Insurance industry and business industry lobbyists, meanwhile, have argued against any additional coverage because of the cost, in states like Pennsylvania.)

The Arbitrator's Findings

The arbitrator's decision document (dated Nov. 20 and issued by Judicial Arbiter Group) which Autism Bulletin received from advocates, provides a window into the health insurance company's policy on autism coverage. Anthem rejected coverage on the grounds that ABA services were not provided in a doctor's office, that ABA was not a medically valid treatment.

Some of Anthem's testimony appears to have been undercut by the fact that administrators and doctors with no experience treating autism cases were making decisions about whether ABA should be covered. Even so, the arbitrator's decision rejects Anthem's arguments and cites the testimony of Philip Strain, an early intervention autism expert and professor of educational psychology at University of Colorado at Denver states:

In his criticism of the Anthem policy, Dr. Strain points out that Anthem erroneously equates ABA therapy with Lovaas therapy—an approach which has received considerable justifiable scientific criticism. ABA therapy is based upon incidental teaching and pivotal response training, which Dr. Strain testified is the standard of care when dealing with autistic children.

According to Dr. Strain, instead of being investigational and experimental, ABA therapy reduces problem behaviors 80 to 90 percent and studies have replicated these results repeatedly.

Finally, Dr. Strain testified that the ABA therapy received by Abby was endorsed by the National Academy of Sciences—the recognized authority in the United States for resolving scientific disputes. Dr. Strain's opinions were echoed b Dr. Huckabee, Abby's treater for autism. Both Dr. Strain's and Huckabee's opinions are supported by the National Institute of Mental Health's publication on Autism Spectrum Disorders: "Among the many methods available for treatment and education of people with autism, applied behavior analysis (ABA) has become widely accepted as an effective treatment. Mental Health: A Report of the Surgeon General states: 'Thirty years of research demonstrated the efficiency of applied behavior methods in reducing inappropriate behavior and increasing social behavior.'"

Remember the American Academy of Pediatrics

The arbitrator's decision in this Colorado also case points out the importance of the recently launched autism awareness campaign at the American Academy of Pediatrics. The full-on effort to educate pediatricians about autism and early interventions to address the condition is likely to lead to more medical prescriptions for therapies such as ABA for young children who are diagnosed with autism spectrum disorders. It will also make it more difficult for health insurers to pledge ignorance about the legitimacy of such approaches.

Also see in the Autism Bulletin archives:

American Pediatricians Make Big Push for Autism Diagnosis, Awareness; Kits for Doctors, Checklists for Parents

Questions and Answers About the Florida Autism Center of Excellence in Tampa

The Florida Autism Center of Excellence (FACE), which opened August 20 in Tampa, Florida, to serve children with autism spectrum disorders, represents an interesting model for a new school. There's been a great deal of interest among Autism Bulletin readers in how the school is set up to help kids and their parents, and below I am publishing the transcript of an e-mail question-and-answer session with representatives of the school about the FACE program.

First, a bit of background. About one year ago, FACE received seed money ($700,000) from the state of Florida to cover starting costs. Students at the school are eligible for partial tuition grants from a state government "school choice" program for children with disabilities. The school is pursuing a program based on the principles of Applied Behavior Analysis (ABA), which means staff seek to manage the behaviors of children to help them learn, to encourage positive behaviors that lead to growth and development and to discourage behaviors that are obstacles to learning.

In addition, the for-profit Educational Services of America, based in Nashville, is responsible for managing the nonprofit FACE school. With such a model, with a rising demand nationally for autism services and educational programs, it's no wonder that there has been a great deal of interest among Autism Bulletin readers in the school, and the specifics of how it's set up. What follows below is the full text of questions I had, plus those collected from readers, and the answers which the school administration sent on November 29 through Lovell Communications, Educational Services of America's public relations agency.

1. What kind of training do teachers receive?

Our teachers receive specific, extensive training that begins before they enter the classroom and continues throughout the school year. Topics include Applied Behavior Analysis and specific methodologies for working with students with autism, such as discrete trial, structured teaching, social skill training and other tools to develop individual education and behavior support plans.

Our school calendar requires an additional 150 hours of formal training, which is supplemented by ongoing coaching and support from the clinical program director and from teachers who mentor their colleagues. Teachers are trained to conduct individual assessments, write lesson plans and collect and analyze data so they can make objective determinations about whether a student is advancing academically, behaviorally and socially. In addition, teachers are required to obtain an Autism Endorsement from an accredited university.

2. What kind of training do one-on-one aides receive?

We staff classrooms to provide the greatest amount of support to promote students’ independence, enhance generalization and encourage relationships with their peers and, therefore, we do not provide one-on-one aides. However, all aides receive the same extensive, specific training the teachers receive.

3. What direct supervision do teachers and aides receive -- how often, how much time per week and from whom?

Teachers and aides receive a high degree of support and supervision. Several teachers serve as mentors to their colleagues and the mentors hold weekly supervision meetings with classroom teachers to provide ongoing training, support and guidance. The clinical program director meets with each mentor teacher weekly. And the clinical director/behavior specialist and school director review each teacher’s weekly lesson plan. Assistants receive formal supervision from the classroom teachers once a week and on-the-job coaching, support and training all day every day.

4. What kind of certification of education and training do you require of staff?

Our teachers are required to meet all state standards plus the standards of the Florida Autism Center of Excellence. Our school calendar requires an additional 150 hours of formal training, which is supplemented by ongoing coaching and support every day. In addition, teachers are required to obtain an Autism Endorsement from an accredited university.

5. How many staff members have advanced training in applied behavior analysis (ABA)?

Educational Services of America, the company FACE hired to manage the school, has seven qualified board certified behavior analysts, including two who provide support and supervision to FACE and conduct on-site training for FACE teachers. The FACE clinical program director earned her master's degree in Applied Behavior Analysis from the University of South Florida and sat for the certification exam in November. The principles of ABA are the very foundation of what we do. For example, our lesson plans include ABA components such as the instruction (discriminative stimulus), the prompt level, the correction and reinforcement plan.

6. Who is responsible for individual behavior plans for students? If an aide has a problem, where does she go for help?

The teacher, the mentor teacher and the clinical program director work collaboratively to develop students’ individual positive behavior intervention plans. If an aide has a problem, he or she goes first to the classroom teacher, then to the mentor teacher, then to the program director.

7. How often does your staff visit with students at home to generalize lessons from school, and work on home-based skills?

Our mission is to educate students in a school environment. Therefore, our staff does not go to students’ homes – rather, we communicate with every parent every day and we invite parents to schedule visits to FACE. In addition, we will soon offer parents additional support they can use at home. Our plan called for us to open FACE in Fall 2007 and offer parent and family initiatives such as training, support groups and a parent-teacher association in Spring 2008 – and we’re on track to do that.

8. What kind of training and education do supervisors have?

One supervisor has a bachelor’s degree in special education, a master’s degree in ABA and sat for the certification exam in November. Another has a bachelor’s degree in business management, a master’s in education and is working toward a doctoral degree in educational leadership. Our lead teachers each have bachelor’s degrees in psychology and seven years of experience working with children with autism. One of our lead teachers has a certification in Exceptional Student Education for students in grades K-12. The executive director of FACE has a bachelor’s degree in social science, a master’s in mental health counseling and is completing a doctoral program in adolescent counseling. He is a board-certified professional counselor and a licensed mental health counselor whose specialty is children and adolescents.

9. How many board certified behavior analysts does FACE employ on site?

ESA has three board-certified behavior analysts, including two who provide direct, ongoing support to FACE and are frequently on campus. The clinical program director, whose office is on campus, has a master’s degree in ABA and sat for the certification exam this month.

10. What is the student-teacher ratio?

We individualize our curriculum and behavior intervention plans for each student, so our student-teacher ratio is based on students’ needs. There is one teacher and one aide for every eight children at the FACE Dale Mabry campus, whose students require more intensive interventions. There is one teacher and one aide for every 15 students at the FACE Chelsea campus, whose students require less intensive interventions.

11. How many students have a one-on-one aide, compared to the total enrollment?

We staff classrooms to provide the greatest amount of support to promote independence, enhance generalization and encourage relationships with peers and, therefore, we do not have one-on-one aides.

12. The autism spectrum can present as a broad array of needs, from severe communications challenges, to highly verbal children who have a diagnosis of Asperger's Syndrome. Do you serve them all? How?

Our mission is to provide a continuum of education and behavioral services to students anywhere on the spectrum. We do this by providing individualized curriculum and behavior intervention plans to meet the specific needs of each student. Students at our Dale Mabry campus require more intensive interventions; students at our Chelsea campus require less intensive interventions. Class sizes are small and students are grouped by according to their age and then by their level of ability. Our small class size, low student-teacher ratio, highly individualized instruction and two campuses enable us to serve students no matter where they are on the spectrum.

13. What kind of parent training do you offer? What do you do to help parents learn about ABA?

We will begin offering parents structured training and support soon. Since FACE opened in the Fall of 2007, we have worked closely with our parents and shared our methodologies and philosophies with them. Our plan called for us to open FACE in Fall 2007 and offer parent and family initiatives such as training, and network and support groups in Spring 2008 – and we’re on track to do that. We can help parents learn about many aspects of ABA, such as positive behavior management, that will help parents and students in their daily lives at home.

14. What other services are available for families from the school?

FACE has partnered with the Boys and Girls Club of Tampa, in part due to a federal grant to establish after school programs for children with special needs. The goal is to provide a comprehensive after school program integrating children at all levels of functioning with a comprehensive academic, social and physical program model. As part of the program, FACE students are teamed with typically developing students from other schools who serve as mentors one day a week. This provides FACE students an opportunity to interact and develop friendships with students who attend other schools.

15. Do you offer any social worker support from the school?

Through our partnership with the Hillsborough County School District, every student and family has access to social work support.

16. What do you say to those who are skeptical that a for-profit parent company can run an effective non-profit organization like FACE? How do you balance the need to maximize revenues, minimize costs and still provide a quality program?

Our mission is to help students with special needs develop academic, behavioral and social skills that will enable them to lead more independent lives. Being a for-profit organization allows us to do this effectively, efficiently and with a high level of quality. Organizations, whether they are non-profit or for-profit, have many of the same fiscal realities – they have income and they have expenses. But there are some important differences. Because we do not have to raise money through charitable donations, we have the resources to focus strictly on helping children. We also feel tremendous accountability. We remain in business because our programs are successful and our families are happy with the results their children achieve.

Editor's Note

As always, you are welcome to leave comments about this exchange with the FACE school. No doubt the FACE administration will see them. In addition, I want to publicly thank the school's administrators for participating in this Q&A.

For more background, also see from Autism Bulletin's archives:

New Florida Autism Charter School Opens in Tampa

Florida Awards $700,000 Grant to Start Tampa Autism Center

Autism Schools Map Project

Advocates, Parents Among Those Appointed to Autism Committee at National Institutes of Health

One theme of the Combating Autism Act of 2006 was to do more to coordinate federal government efforts on autism research and diagnostic screening along with autism services and education programs. Following this directive, Mike Leavitt, the Bush Administration's secretary of Health and Human Services, on Nov. 27 announced 19 appointments to the government's Interagency Autism Coordinating Committee.

The committee's goal is to make sure government agencies are sharing information so they can coordinate their respective efforts on various autism-related programs. You can read Leavitt's full announcement by clicking here.

While the law calls for the director of the Centers for Disease Control to be appointed to this panel, Leavitt instead appointed another CDC official to represent the agency head, Julie Gerberding. (You can read the text of the Combating Autism Act here in a PDF file. For those of you interested in the specific section of the law pertaining to this committee, read to the end of this post.)

The committee chair is Thomas R. Insel, M.D., director of National Institutes for Mental Health. "The committee's first priority will be to develop a strategic plan for autism research that can guide public and private investments to make the greatest difference for families struggling with autism," Dr. Insel said in a statement.

Four Parents, One Autistic Adult Appointed to the Committee

The law calls for the committee to have one-third of its members come from the public at large, and at least one person with autism, one parent and one member of the autism advocacy organization. Levitt's six choices to fill these roles are below, with notes from the government's press release and some associated website links:

Stephen Shore, Ed.D., the executive director of Autism Spectrum Disorder Consulting. See his website at www.autismasperger.net. Shore has an autism spectrum disorder diagnosis. He is an education consultant who is an expert "on adult issues pertinent to education, relationships, employment, advocacy, and disclosure." Shore serves on the board of the Autism Society of America, as board president of the Asperger's Association of New England, and is on the board of directors for Unlocking Autism, the Autism Services Association of Massachusetts, MAAP Services, The College Internship Program, and the KEEN Foundation.

Parent Lee Grossman, the president and CEO of Autism Society of America (ASA), a leading advocacy organization based near Washington D.C. He is the parent of a young adult son with autism. Mr. Grossman is also the chair of the ASA Foundation and a member of the ASA Environmental Health Advisory Board.

Parent Christine McKee is a lawyer who has developed and manages an in-home therapy for her autistic child. She participates in monthly consultations with a Board Certified Behavior Analyst/Speech Pathologist. She applies the therapeutic measures in her daily parenting and childcare routines.

Parent Lyn Redwood is co-founder and president of the advocacy group Coalition for Safe Minds. The coalition is a private nonprofit organization "founded to investigate and raise awareness of the risks to infants and children of exposure to mercury from medical products, including thimerosal in vaccines." She is a nurse practitioner who has 25 years of experience, and began her advocacy efforts for autism research after her son was diagnosed with pervasive development disorder in 1999."

Parent and sibling Alison Tepper Singer is executive vice president of Autism Speaks and is a member of the board of directors. Prior to joining Autism Speaks, Ms. Singer spent 14 years at CNBC and NBC where she served in several positions. She has both a daughter and an older brother with autism, giving her long-term, personal experience with the disorder.

Yvette Janvier, M.D., is the medical director for Children's Specialized Hospital in New Jersey. Dr. Janvier is also a clinical assistant professor in the Department of Pediatrics, Robert Wood Johnson Medical School. Her specialties are autism and developmental and behavioral
pediatrics. Dr. Janvier is a fellow of the American Academy of Pediatrics.

Government Officials on Committee

Secretary Leavitt appointed 13 government officials and researchers to this committee. They are:

Duane Alexander, M.D., director of the National Institute of Child Health and Human Development at NIH. The Institute supports research on all stages of human development, from preconception to adulthood, to better understand the health of children, adults, families, and communities.

James Battey, M.D., is director of the National Institute on Deafness and Other Communications Disorders at NIH. The Institute supports biomedical and behavioral research and research training in the normal and disordered processes of hearing, balance, smell, taste, voice, speech, and language.

Ellen Blackwell is a social worker and health insurance specialist of the Division of Community and Institutional Services, Disabled and Elderly Health Programs Group, Center for Medicaid and State Operations, Centers for Medicare and Medicaid Services where she serves as an expert on policies that affect individuals with autism spectrum disorders.

Margaret Giannini, M.D., is director of the HHS Office on Disability. Dr. Giannini serves as advisor to the Secretary on HHS activities relating to disabilities. She is also a member of the Institute of Medicine of the National Academy of Sciences and fellow of the American Academy of Pediatrics.

Gail Houle, is associate division director of the Research-to-Practice Division, Early Childhood Programs, Office of Special Education Programs, Department of Education where she oversees programs for children with disabilities and their families funded through the Individual with Disabilities Education Act. Her expertise focuses on services for children with autism spectrum disorders.

Larke Huang is senior advisor on children and a licensed clinical-community psychologist who provides leadership on federal national policy pertaining to mental health and substance use issues for children, adolescents and families for the Substance Abuse and Mental Health Services Administration.

Thomas Insel, M.D., is director of the National Institute of Mental Health at NIH. The Institute's mission is to reduce the burden of mental illness and behavioral disorders through research on mind, brain, and behavior.

Story Landis is director of the National Institute of Neurological Disorders and Stroke at NIH. The Institute's focus is directed toward reducing the burden of neurological disease through research on the normal and diseased nervous system.

Cindy Lawler is scientific program director of the Cellular, Organs, and Systems Pathobiology Branch, Division of Extramural Research and Training, National Institute of Environmental Health Sciences at NIH. The Branch plans, directs, and evaluates the Institute's grant program that supports research and research training in environmental health.

Patricia Morrissey is commissioner of the Administration on Developmental Disabilities at the Administration for Children and Families, which seeks to improve services to and assure that individuals with developmental disabilities have opportunities to make their own choices, contribute to society, have supports to live independently, and are free of abuse, neglect, financial and sexual exploitation, and violations of their legal and human rights.

Edwin Trevathan, M.D., is director of the National Center on Birth Defects and Developmental Disabilities (NCBDDD) at CDC. NCBDDD is focused on identifying the causes of and preventing birth defects and developmental disabilities, helping children to develop and reach their full potential, and promoting health and well-being among people of all ages with disabilities. Dr. Trevathan is representing Julie Gerberding, M.D., M.P.H., director of the CDC, on the committee.

Peter van Dyck, M.D., M.P.H., is associate administrator of Maternal and Child Health at the Health Resources and Services Administration (HRSA). Dr. van Dyck oversees HRSA's Maternal and Child Health Bureau, which seeks to improve the health of mothers, children, and families, particularly those who are poor or lack access to care.

Elias Zerhouni, M.D., is director of the National Institutes of Health. A world renowned leader in the field of radiology and medicine, Dr. Zerhouni has spent his career providing clinical, scientific, and administrative leadership. He leads the nation's medical research agency and oversees the NIH's 27 Institutes and Centers with more than 18,000 employees.

Notes on This Panel from the Combating Autism Act

The law calls for the committee to meet at least twice a year, in public. Here's what the law says about its goals:

In carrying out its duties under this section, the Committee shall—

(1) develop and annually update a summary of advances in autism spectrum disorder research related to causes, prevention, treatment, early screening, diagnosis or rule out, intervention, and access to services and supports for individuals with autism spectrum disorder;

(2) monitor Federal activities with respect to autism spectrum disorder;

(3) make recommendations to the Secretary regarding any appropriate changes to such activities, including recommendations to the Director of NIH with respect to the strategic plan developed under paragraph (5);

(4) make recommendations to the Secretary regarding public participation in decisions relating to autism spectrum disorder;

(5) develop and annually update a strategic plan for the conduct of, and support for, autism spectrum disorder research, including proposed budgetary requirements; and

(6) submit to the Congress such strategic plan and any updates to such plan.

Related Stories on Autism Bulletin:

CDC Director Cites Autism as Urgent Concern

Bush Signs Combating Autism Act

National Institutes of Health Reorganizes Autism Research Program

Federal Research Grants Shows Intensified Effort to Find Autism Clues, Treatments, NIH Says