Monday, June 9, 2014, three families filed a class action lawsuit seeking to represent all Pennsylvania children with Autism Spectrum Disorder who are enrolled in Pennsylvania’s Medical Assistance program and require Applied Behavioral Analysis (ABA) therapy.

The families allege that the Department of Public Welfare (DPW) fails to cover ABA services in an amount or scope that is consistent with medically accepted standards.


ABA is a nationally recognized treatment for autism with strong evidence of success. While DPW has not disputed this fact, they do not cover ABA as a distinct service. Instead they require children with autism to get their behavioral services through a program designed for children with emotional, rather than developmental, disorders.

As a result, DPW severely limits the scope of services to those aimed at the behavioral symptoms of autism and refuse to cover 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 is to provide intensive ABA 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 ABA 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, can get the services they need.

 

Source: https://www.drnpa.org/disability-rights-network-files-class-action-lawsuit-to-ensure-full-medical-assistance-coverage-of-applied-behavioral-analysis-for-children-with-autism-spectrum-disorder/

 

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