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Autism Private Health Insurance Impact on the IEP and ISP

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. 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?

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

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.

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:

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.
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.
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.

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. 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. A tip is to make sure you are actively involved in the program- reviewing data, goals and progress with your provider.
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. 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.

This list is not meant to be exhaustive and as we go foward with following the progress of this law, we will update this post. Meanwhile, be sure to visit us on our website for more updates.