Autism Private Health Insurance Impact on the IEP - Special Education Attorney California. special education attorney,disability attorney, federal litigation, state litigation

1. Autism Private Health Insurance
Impact on the IEP and ISP

2. The Autism Private Health Insurance
Mandate Reform bill was signed by
Governor Brown. The law provides for
behavioral treatment services for
individuals with autism or pervasive
developmental disorder through their
private health insurance plans.

3. Each plan is required to keep and
maintain an adequate list of behavioral
treatment options. However, how will
this impact school special education
services and regional center services?

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 also
provide coverage for behavioral health
treatment for pervasive
developmental disorder or autism no
later than July 1, 2012

5. 2. This section shall not affect or
reduce any obligation to provide
services under an individualized
education program, or under an
individualized service plan.

6. The key here is that school districts
must still look to the child’s unique
needs in order to determine IEP
services. Additionally, Regional Center
clients receiving Individual Services
Plans cannot use the new law to deny
services under an ISP.

7. From a special education attorney’s
perspective practically speaking there
may be pro’s and cons at the IEP and
ISP meetings. A few examples of pros
and cons:

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 ABA
therapy isn’t required for your child to
learn or to benefit.

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 valuable
information to the participants and be
a wonderful supporter of more
behavioral therapy.

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 in
special education due process hearings
that ABA is not scientifically based and
proven as a method helpful for
children with autism.

11. Now, the cons:
1. The coin flips both ways, if a child
who is not making progress using
behavior therapy fails to meet goals,
the question then is whether this is
evidence that ABA is not the
appropriate method.

12. Obviously, a school district or regional
center 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. A tip is to make sure you are actively
involved in the program- reviewing
data, goals and progress with your
provider.

14. 1. The coin flips both ways, if a child
who is not making progress using
behavior therapy fails to meet goals,
the question then is whether this is
evidence that ABA is not the
appropriate method.

15. Obviously, a school district or regional
center 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. A tip is to make sure you are actively
involved in the program- reviewing
data, goals and progress with your
provider.

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 education
directors make this argument time and
time again- and unfortunately, cases
have been ruled in favor of district’s on
this argument.

18. Make sure you and the behaviorist are
prepared at IEP and ISP meetings to tie
in the program’s benefits to those that
could equally be matched in a school
setting.

19. This list is not meant to be exhaustive
and as we go foward with following
the progress of this law.

20. The Leigh Law Group represents
individuals, families, employees,
parents, guardians and children who
have been injured by the unlawful acts
of others. As attorney advocates, we
provide each client with all options
available to them.

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. Specialties include special education
attorney, federal court litigation, state
court litigation, disabilty
discrimination, disability rights
attorney, and civil rights. Please visit
us on the web at
http://www.leighlawgroup.com