BILL REQ. #:  S-4457.2 

Read first time 01/24/08.   Referred to Committee on Health & Long-Term Care.

     AN ACT Relating to creating autism spectrum disorders diagnostic clinics in public hospital districts; and creating new sections.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF WASHINGTON:

NEW SECTION.  Sec. 1   The legislature finds that autism spectrum disorders are not rare, and are, in fact, chronic conditions that affect nearly one of every one hundred fifty children and require ongoing medical and nonmedical interventions. The legislature further finds that, while not rare, access to accurate and efficient diagnostic services to identify the clinical characteristics of these disorders are. Despite increased access to service with the establishment by the legislature of the Tacoma satellite in 2005, there exists a six month to one-year waiting list for diagnosis across the state. It is critically important to children and families that they have timely and reliable access to providers who can recognize the signs and symptoms of autism spectrum disorders and have a strategy for screening, surveillance, and assessing them systematically. While forty-four percent of physicians say they care for more than ten children with autism spectrum disorder, only eight percent say they routinely screen for it. Physicians must also know about local resources that can assist in making a definitive diagnosis of and in managing autism spectrum disorders. To assist children, families, and the providers caring for these children and their families, the legislature finds that early and accurate diagnosis of autism spectrum disorders should be made available and accessible to the majority of people within their local communities through public hospital districts.
     The legislature also finds that public hospital districts enjoy the benefits of not-for-profit status. Public hospital districts also enjoy the benefit of additional revenue raised from taxing residents who live within their boundaries. While residents who live within those taxing boundaries benefit from access to the health care services provided, so do those that live outside the taxing boundaries. The legislature finds that all residents in the taxing district should receive meaningful remuneration from the benefits that accrue to these health care entities.
     The legislature finds that early, accurate, and efficient diagnosis of autism spectrum disorders should be made available through public hospital districts because such a diagnosis will enable the primary goal of treatment. Children with autism can be accurately diagnosed as early as sixteen months of age, and professionals have the ability to identify those who are at risk as early as ten months of age, but children of all ages shall be served. Treatment of autism spectrum disorder is to maximize the child's ultimate functional independence and quality of life by minimizing the core autism spectrum disorder features, facilitating development and learning, promoting socialization and functional independence and quality of life, reducing maladaptive behaviors, and educating and supporting families and reducing family distress. Without an accurate diagnosis, children and families may not receive empirically supportive health care treatment and interventions which are likely to have a positive effect on habilitative progress, functional outcomes, and quality of life.
     Timely diagnosis and intervention can result in a significant increase in intelligence quotient and language ability and a decrease in special education services needed later in childhood. The average intelligence quotient of children receiving intensive early intervention is twenty-eight points. Many children who had severe below-normal cognition at the beginning of intervention were functioning in the normal cognitive range and attending regular education classrooms by five years of age. These results stand in stark contrast to the very poor outcomes of children who do not receive early diagnosis, treatment, and intervention.
     Access to diagnosis and intervention are also critical to financial health and well-being. Because of the remarkable response to intervention, cost savings are substantial to individuals with autism, their families, and society. Cost-benefit analyses published in peer-reviewed journals estimate that the lifetime net financial cost savings to society per individual who receives intensive early intervention is two and one-half to three million dollars. The impact of timely diagnosis and intervention on the quality of life for individuals with autism and their families is immeasurable.

NEW SECTION.  Sec. 2   Public hospital districts, as defined in RCW 70.44.007, shall, within existing revenue, develop a team of qualified diagnosticians prepared to assess and diagnose autism spectrum disorders for free for people living within the taxing borders of a public hospital district and at reduced cost for people living outside the taxing borders of the public hospital district. Once the diagnosis is made or suspected, the child and his or her family shall be referred to treatment and early intensive intervention services.
     (1) The diagnostic team's composition will include at a minimum a core provider team made up of a psychologist, a pediatrician, and another primary care provider with expertise in pediatrics, but may also include a psychiatrist, and a master degree social worker. The addition of the diagnostic team is intended to make a public hospital district a comprehensive center for children with autism and their families. The diagnostic team shall regularly travel in the region served by the public hospital district and host clinics accessible to children and their families.
     (2) The diagnostic team shall provide the following services to children from the ages of ten months to twenty-one years:
     (a) Assessment of a child's cognitive/developmental skills;
     (b) Semistructured assessment of their social, language, and play/recreational skills;
     (c) Thorough history using standardized tools;
     (d) A neurodevelopmental evaluation by a developmental pediatrician, neurologist, or pediatrician well-versed in autism spectrum disorders; and
     (e) Comorbid risk for sleep, gastrointestinal, psychiatric, genetic, and metabolic disorders.
     Access to intervention and services is best provided with the inclusion of social work to help a family navigate initial diagnosis and community supports.

NEW SECTION.  Sec. 3   The autism centers at Tacoma and Seattle shall provide the evidence-based standard model for diagnosis and access to intervention to be used by the public hospital districts.