Since December 2012, the Autism Speaks Legal Resource Center has provided advice and assistance to attorneys and advocates in over 14 states and is monitoring litigation and enforcement in several others. Here are our active cases:
Florida Medicaid (K.G v Dudek)
Autism Speaks filed an amicus brief in the Eleventh Circuit Court of Appeals in support of Florida Legal Services which won a favorable ruling in 2012 concerning the right of children on Medicaid to access ABA. The appeals court on September 20, 2013 affirmed the substance of the trial court order, but remanded the case in part to clarify the state's authority to determine ABA eligibility on the basis of medical necessity. Autism Speaks also provided advice and assistance to Plaintiffs’ attorneys when the case was pending.
Major Medicaid Breakthrough Announced For Autism (July 8, 2014)
Order Directing Florida Medicaid to Cover ABA Upheld on Appeal (September 23, 2013)
Court Accepts Autism Speaks' Brief in Florida Medicaid Case (February 1, 2013)
Florida Appeals Federal Order to Cover ABA Under Medicaid (January 7, 2013)
Autism Speaks Hails Ruling by Federal Judge Ordering Medicaid Coverage (March 26, 2012)
Pennsylvania Denials Appeal (Anthony Burke v Independence Blue Cross)
Autism Speaks filed an amicus brief before the Pennsylvania Supreme Court in support of the plaintiff's appeal of a lower court ruling that held only insurance companies, and not policyholders, have a right to appeal adverse decisions on insurance claims. The case involves a boy with autism whose claims for coverage of applied behavior analysis (ABA) provided by his parochial school were denied. The family won in trial court, but the decision was overturned by an appeals court which found that only insurance companies, not policholders, have a right to appeal adverse decisions. That ruling is before the state Supreme Court on appeal.
Ohio Early Intervention
Counsel handling federal district court litigation in Ohio challenging the state’s refusal to provide ABA in its early intervention program reached out to the ASLRC for assistance. The Center is working with Disability Rights Ohio and local counsel through Autism Speaks Federal Legal Appeals Project to provide amicus briefing and will be available to provide further support as the litigation proceeds.
Feds Tell Ohio to Cover ABA Under 'Help Me Grow' September 13, 2013
New York ABA Licensing
Following the enactment of New York's 2011 autism insurance reform law, the state Department of Financial Services issued emergency regulations which imposed a licensure requirement on ABA providers that is contrary to statute. In July 2013, the agency modified the regulations by withdrawing the licensing requirement and providing that national certification through the Behavior Analyst Certification Board would be sufficient. The Autism Speaks Legal Resource Center and local counsel worked with key stakeholders to proceed with litigation if necessary to challenge the DFS regulations, while corrective statutory language was voted out of the Legislature. ASLRC continued to work closely with the Autism Speaks government relations team and it’s champions in the Legislature to win enactment of an ABA licensing law.
Cuomo Enacts NY ABA Licensing Law January 10, 2014
NY Clears Roadblock to ABA Insurance Coverage July 31, 2013
NY ABA Licensure Bills Win Autism Speaks' Support May 29, 2013
Autism Speaks: New York ABA Rules 'Ignore' 2011 Reform Law January 28, 2013
New Jersey Insurance Reform Implementation Issues
On March 17, 2013, a legislative hearing was held in New Jersey to examine difficulties encountered by New Jersey families trying to access autism insurance benefits supposed to be provided pursuant to that state's 2009 autism insurance reform statute. After the hearing, key stakeholders were directed to work to resolve these issues; the first hearing was held in September 2013. ASLRC is working closely with local advocates to develop recommendations to resolve the myriad issues that have impeded full access to the intended benefits, including difficulties in claims procedures, authorizations, network adequacy other issues.
NJ Stakeholders Address Disputes Over Insurance Law September 13, 2013
N.J. law mandating autism treatment coverage needs work, parents and lawmakers say NJ.com, March 7, 2013
California Consumer Watchdog Litigation (Consumer Watchdog v DMHC)
ASLRC prepared an amicus briefing pursuant to a request by the California Court of Appeals for a hearing on restrictions imposed by California’s Department of Managed Health Care on ABA providers that limit access to care for state employees and lower-income families, but do not apply to other health plans in the state. The court struck down the restrictions in September 2013.
Licensing Struck Down As Basis For ABA Denials in California April 25, 2014
CA State Employees Gain ABA Coverage through Court Ruling September 11, 2013