State insurance plan must cover autism therapy, judge rules

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News from Washington (state)

In a victory for people with autism, a King County Superior Court judge ruled June 7 that a  blanket exclusion for a certain type of autism therapy by the state employees’ health care program violates state law.

The Washington State Health Care Authority had previously excluded coverage for applied behavioral analysis therapy, which often requires children with autism undergo 24 to 40 hours a week of therapy at a cost of as much as $50,000 per year.

The court said that under the Mental Health Parity Act, “Defendants are required to cover medically necessary applied behavior analysis therapy, as determined on an individualized basis, when provided by licensed providers.”

The Mental Health Parity Act passed the state legislature in 2005 and went fully into effect in July 2010. The law requires mental health services be covered by health plans in a manner comparable in scope and limitations to other health services. The law states that the health care authority must cover mental disorders covered by the Diagnostic and Statistical Manual of Mental Disorders, with a few narrow exceptions.

The Health Care Authority argued it was not required to cover the therapy because it is often not provided by licensed medical providers. The court ruled that the blanket exception violated the act because the therapy, in fact, is sometime provided by licensed medical providers, including in the cases of the two families listed in the lawsuit.

The court did not rule whether the state was required to provide insurance coverage for the therapy when it is provided by non-licensed providers.

“This decision is a life-saver for many families who have a child with autism,” said Arzu Forough, a parent of two of the plaintiffs, and a representative of the national advocacy group Autism Speaks, according to a Mental Health Parity Coalition news release.

“We urge the Health Care Authority to implement Judge (Susan) Craighead’s decision immediately so that all children of public employees who have autism can get access to this essential therapy,” Forough said.

The Mental Health Parity Coalition was created in 1995 in an effort to end discrimination in the provision of health insurance coverage of medically necessary services.