Disability Rights Network files class action lawsuit to ensure full Medical Assistance coverage of Applied Behavioral Analysis for children with Autism Spectrum Disorder.

Sharing their on-going struggles to get the services their young children need to maximize their potential for independence and success in life, on Monday, June 9, three families filed a class action lawsuit seeking to represent all Pennsylvania children with Autism Spectrum Disorder who are enrolled in MA and need Applied Behavioral Analysis.  The families allege that the Department of Public Welfare (DPW) fails to cover Applied Behavioral Analysis services in an amount or scope that is consistent with medically accepted standards.

Applied Behavioral Analysis is a nationally recognized treatment for Autism Spectrum Disorder with strong evidence of success.  While DPW has not disputed this fact, they do not cover Applied Behavioral Analysis as a distinct service.  Instead they require children with Autism Spectrum Disorder to get their behavioral services through a program designed for children with emotional, rather than developmental, disorders.  As a result, they limit the scope of services to those aimed at the behavioral symptoms of Autism Spectrum Disorder and will not pay for services that focus more directly on developing social, self-help and communication skills.  While the generally accepted standard of care in the field of Autism Spectrum Disorder is to provide intensive Applied Behavioral Analysis therapy to young children as soon as they are diagnosed with a significant Autism Spectrum Disorder, often by the age of two, DPW’s policies do not allow intensive services until a child is at risk of out-of-home or out-of-school placement.   DPW’s own Autism Bureau has written that this mental health service is not a good fit for children with Autism Spectrum Disorder. The families want DPW to cover Applied Behavioral Analysis as a distinct service using the standards and criteria that are generally accepted in the medical community for this service, so that their children, and all children with Autism Spectrum Disorder, can get the services they need.