California Court Rules that Private Insurer Must Pay for Autism Therapy

A Los Angeles trial court has issued a preliminary ruling that private insurance companies must pay for applied behavioral analysis treatments for children with autism. The Court found that a memo by a state agency permitting denials of coverage for such treatments was an in valid form of regulation that conflicts with a state law requiring insurers to cover mental and emotional health problems equally to physical problems. Here is the news article from the L. A. Times.

It should be noted that this is just a preliminary ruling. As long time readers of this blog know, legal disputes are never over until they're over. (I couldn't resist quoting Yogi Berra with the World Series on the horizon. Next year it will be the Cubs; do you know how many years I have been saying that?) The case has not yet been decided. There is much more yet to come.

If the preliminary ruling stands however, this could be an important decision. It

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also may impact special education law. Many parents have attempted to have their school systems provide or reimburse for ABA treatments. These have sometimes been successful, but often get stuck in the methodology category. Since the Rowley decision, courts have held that methodology choices are the province of professional educators. Where a district program denied FAPE, however, some hearing officers and courts have ordered ABA programs. If insurance companies must pay for ABA treatments or programs, (and as I said above, we are a long way from that being "the law.") there may be fewer attempts to look to school districts to pay for such services.

What do you think about this?

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