Autism Private Health Insurance Impact on the IEP - Special Education Attorney California

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Autism Private Health Insurance Impact on the IEP - Special Education Attorney California

  1. 1. Autism Private Health Insurance Impact on the IEP and ISP
  2. 2. The Autism Private Health Insurance Mandate Reform bill was signed byGovernor Brown. The law provides for behavioral treatment services for individuals with autism or pervasivedevelopmental disorder through their private health insurance plans.
  3. 3. Each plan is required to keep andmaintain an adequate list of behavioraltreatment options. However, how will this impact school special educationservices and regional center services?
  4. 4. Key provisions from the bill:1. SECTION 1374.73 of the Health and Safety Code: (a) (1) Every health care service plan contract that provides hospital,medical, or surgical coverage shall alsoprovide coverage for behavioral health treatment for pervasive developmental disorder or autism no later than July 1, 2012
  5. 5. 2. This section shall not affect orreduce any obligation to provideservices under an individualizededucation program, or under an individualized service plan.
  6. 6. The key here is that school districts must still look to the child’s unique needs in order to determine IEPservices. Additionally, Regional Center clients receiving Individual ServicesPlans cannot use the new law to deny services under an ISP.
  7. 7. From a special education attorney’sperspective practically speaking theremay be pro’s and cons at the IEP andISP meetings. A few examples of pros and cons:
  8. 8. Good news first: 1. With highly effective behavioral therapy showing progress in therapy outside of the school setting, schools and regional centers will be less likely to be able to speculate that ABAtherapy isn’t required for your child to learn or to benefit.
  9. 9. 2. With a highly effective behavioral therapy program in place, you now have new person to consider inviting to your IEP and ISP meetings. This person can provide valuableinformation to the participants and be a wonderful supporter of more behavioral therapy.
  10. 10. 3. The law now states firmly that behavioral therapy is an evidence based form of treatment for autism. Let’s hope this takes us out of the dueling expert battles we see inspecial education due process hearingsthat ABA is not scientifically based and proven as a method helpful for children with autism.
  11. 11. Now, the cons:1. The coin flips both ways, if a child who is not making progress usingbehavior therapy fails to meet goals,the question then is whether this is evidence that ABA is not the appropriate method.
  12. 12. Obviously, a school district or regionalcenter looking to avoid ABA therapy in the schools will want to use this information to state that the treatment isn’t appropriate. Keep in mind, however, that the new health law requires that the goals set in the program be reviewed every six months.
  13. 13. A tip is to make sure you are actively involved in the program- reviewing data, goals and progress with your provider.
  14. 14. 1. The coin flips both ways, if a child who is not making progress usingbehavior therapy fails to meet goals,the question then is whether this is evidence that ABA is not the appropriate method.
  15. 15. Obviously, a school district or regionalcenter looking to avoid ABA therapy in the schools will want to use this information to state that the treatment isn’t appropriate. Keep in mind, however, that the new health law requires that the goals set in the program be reviewed every six months.
  16. 16. A tip is to make sure you are actively involved in the program- reviewing data, goals and progress with your provider.
  17. 17. 2. District’s or Regional Centers may attempt to separate this sort of therapy as “clinical” in nature rather than being “naturalistic”. Believe me- our firm has seen special educationdirectors make this argument time and time again- and unfortunately, caseshave been ruled in favor of district’s on this argument.
  18. 18. Make sure you and the behaviorist areprepared at IEP and ISP meetings to tiein the program’s benefits to those that could equally be matched in a school setting.
  19. 19. This list is not meant to be exhaustive and as we go foward with following the progress of this law.
  20. 20. The Leigh Law Group represents individuals, families, employees, parents, guardians and children whohave been injured by the unlawful acts of others. As attorney advocates, we provide each client with all options available to them.
  21. 21. When Leigh Law Group acts on your behalf, we demonstrate a strong commitment to your case and are relentless in our goals for seeking remedies and justice.
  22. 22. Specialties include special educationattorney, federal court litigation, state court litigation, disabilty discrimination, disability rightsattorney, and civil rights. Please visit us on the web at http://www.leighlawgroup.com

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