An Expert Witness who reviews life care plans and future costs under the Affordable Care Act should be aware of the interaction between existing statutes of the past four decades and the ACA. In situations where a Plaintiff has conditions such as Pervasive Developmental Disorders (PDD) which would include for example Autism, and workplace accommodations for Multiple Sclerosis. The Patient Protection and Affordable Care Act provides for increased consumer education and awareness about healthcare and insurance benefits.
One effect of the ACA is that there is significant funding for publicly available education materials on the Internet via both Federal resources (e.g. Healthcare.gov) and Federal funding via States (e.g. N for parents of children with Developmental Disabilities including Pervasive Developmental Disorders such as autism or Multiple Sclerosis). In my opinion, improved access to educational materials improves access to care and access to financial assistance via a wider variety of already available programs. Here are just a few that the ACA either re-enforces or, via education and access, creates improved utilization:
Section 1557 of the Patient Protection and Affordable Care Act (ACA), punctuates other pre-existing regulations regarding people with disabilities. Section 1557 is intended to “…ensure that an individual is not excluded from participating in, denied benefits because of, or subjected to discrimination as prohibited under Section 504 of the Rehabilitation Act of 1973 (disability), under any health program or activity, any part of which is receiving federal financial assistance, or under any program or activity that is administered by an Executive Agency or any entity established under Title I of the Affordable Care Act or its amendments.” [i]
The Individuals with Disabilities Education Act (IDEA) Education services and support, including Assistive Technology is often covered 100% via compliance to IDEA, depending on local State Medicaid and Medicaid Waiver Policies.
Do I have to tell a potential employer I have MS I would Like Workplace Accommodations for MS?
According to the Multiple Sclerosis Society, you must provide information about your medical condition if you are requesting accommodation for the interview process. If your disability is not obvious and you do not need accommodations for the interview process, you can decide whether you would like to share your diagnosis or not. A potential employer can ask for additional information if they need evidence to determine whether you meet the ADA’s de nition of person with a disability; this request may include information about your diagnosis. In general, any time an accommodation is requested (during the interview process, after a job o er has been made, or after employment has started), employers may
ask for information about your medical condition to make sure that you fall under ADA protection. In some cases, this may include questions about your diagnosis.
Do I have to take a medical examination to get a job?
According to the Multiple Sclerosis Society, employers are allowed to ask potential employees to demonstrate how they would perform an essential job function during the interview stage (e.g. show or describe how they would lift 50 pounds). But they are generally prohibited from conducting medical examinations or asking disability-related questions.
After the employer makes a job o er, they may then require the employee to answer medical questions and/ or take a medical exam — as long as they are asking for the same information from all persons o ered the same position. ey may make the job o er contingent upon the results of the medical information/exam. However, if the employer withdraws the job o er due to the disability-related information that was obtained, the employer must show the decision was job-related, due to current, speci c impairment, and that reasonable accommodation was not possible.
What are Pervasive Developmental Disorders?
According to the National Institutes of Health (NIH), The diagnostic category of pervasive developmental disorders (PDD) refers to a group of disorders characterized by delays in the development of socialization and communication skills.
Parents may note symptoms as early as infancy, although the typical age of onset is before 3 years of age. Symptoms may include problems with using and understanding language; difficulty relating to people, objects, and events; unusual play with toys and other objects; difficulty with changes in routine or familiar surroundings, and repetitive body movements or behavior patterns. Autism (a developmental brain disorder characterized by impaired social interaction and communication skills, and a limited range of activities and interests) is the most characteristic and best studied PDD. Other types of PDD include Asperger’s Syndrome, Childhood Disintegrative Disorder, and Rett’s Syndrome. Children with PDD vary widely in abilities, intelligence, and behaviors. Some children do not speak at all, others speak in limited phrases or conversations, and some have relatively normal language development. Repetitive play skills and limited social skills are generally evident. Unusual responses to sensory information, such as loud noises and lights, are also common.
What Are the Symptoms of Pervasive Developmental Disorders?
According to WebMD,
The use of the word “pervasive” to describe these illnesses is somewhat misleading. The definition of pervasive is “to be present throughout,” but children with PDDs generally do not have problems in all areas of functioning. Rather, most children with PDDs have specific problem areas and often function very well in other areas.
Children with PDDs, such as autism, can display a wide range of symptoms that range from mild to disabling. They also vary widely in their individual abilities, intelligence, and behavior.
General symptoms that may be present to some degree in a child with a PDD include:
- Difficulty with verbal communication, including problems using and understanding language
- Difficulty with non-verbal communication, such as gestures and facial expressions
- Difficulty with social interaction, including relating to people and to his or her surroundings
- Unusual ways of playing with toys and other objects
- Difficulty adjusting to changes in routine or familiar surroundings
- Repetitive body movements or patterns of behavior, such as hand flapping, spinning, and head banging
- Changing response to sound; the child may be very sensitive to some noises and seem to not hear others.
- Temper tantrums
- Difficulty sleeping
- Aggressive behavior
- Fearfulness or anxiety
What are the Symptoms of Multiple Sclerosis?
The literature does not include Multiple Sclerosis as a PDD. However, according to the Mayo Clinic, signs and symptoms include:
- Numbness or weakness in one or more limbs that typically occurs on one side of your body at a time, or the legs and trunk
- Partial or complete loss of vision, usually in one eye at a time, often with pain during eye movement
- Prolonged double vision
- Tingling or pain in parts of your body
- Electric-shock sensations that occur with certain neck movements, especially bending the neck forward (Lhermitte sign)
- Tremor, lack of coordination or unsteady gait
- Slurred speech
- Problems with bowel and bladder function
There are over 150 ICD-9 diagnosis codes, 150 ICD-10 CM diagnosis codes and over 150 CPT outpatient procedure codes related to MS. We defer to medical opinions regarding the similarities but one can see how the signs and symptoms of MS are similar to the criteria for determining whether one has PDD and what assistive technologies under the Americans with Disabilities Act and (IDEA)
[i] U.S. Health and Human Services Office of Civil Rights. http://www.hhs.gov/civil-rights/for-individuals/disability/