Florida Medicaid Must Cover Therapy for Autism

as seen on http://www.theledger.com/article/20120327/NEWS/120329396?p=1&tc=pg

LAKELAND | Florida’s Medicaid program must cover applied behavioral analysis for children who are diagnosed with autism and related disorders, a federal judge in Miami ruled Monday morning.

An estimated 8,500 Florida children on Medicaid are identified now as having full-blown autism or related conditions falling under the umbrella of autism spectrum disorder. The decision will benefit them, along with other children diagnosed with those disorders in the future who need behavioral health therapy.

U.S. District Court Judge Joan Lenard called the state’s decision not to cover ABA therapy “arbitrary, capricious and unreasonable, both in its process and in its conclusion.”

The Florida Agency for Health Care Administration didn’t follow its standard process for determining whether a treatment or service should be covered when it ruled against applied behavioral analysis. It didn’t apply the state’s definition of experimental and failed to use “reliable evidence” as defined by Florida law, Lenard said in the permanent injunction order against the state agency.

The agency has a month in which to appeal the injunction if it chooses to do so.

“We’re so excited about the decision,” said Betsy E. Havens of Florida Legal Services Inc. in Miami.

“We think it will help pave the way for a lot of other state Medicaid programs.”

Havens is one of the lawyers representing three autistic children in Dade County who were denied Medicaid coverage of ABA therapy despite having been referred for it by the neurologists treating them.

Autism is a developmental disability significantly affecting verbal and nonverbal communication and social interaction that adversely affects a child’s educational performance, according to a federal definition. It usually is evident before age 3.

The National Institutes of Health and the U.S. Surgeon General recognized ABA “years ago” as the most effective treatment for children with autism spectrum disorder, said Terry Millican, executive director of Central Florida Autism Institute in Lakeland.

“Anything mandating behavior intervention is a good thing,” Millican said, explaining that ABA provides intensive, early, behavior-based intervention. It uses structured, one-on-one therapy.

“I can’t believe (the state) would say it’s experimental,” she added.

Central Florida Autism Institute includes a center that does applied behavioral analysis and therapy, which has been provided there for about six years.

Children are taught, among other things, how to make connections with others, to communicate better and to learn language.

“These kids can have more normal lives,” Havens said.

Autism spectrum disorder, or ASD, is a range of complex disorders, characterized by social impairments, communication difficulties, and restricted, repetitive, and stereotyped behavior patterns. Autistic disorder is the most severe form.

An average of 1 in 110 children has an ASD, about 1 percent of children. That comes from the Centers for Disease Control and Prevention’s Autism and Developmental Disabilities Monitoring Network.

Males are four times more likely than females to have ASDs, according to the National Institute of Neurological Disorders and Stroke.

One of the three children in the lawsuit leading to Monday’s injunction received applied behavioral analysis under an earlier, preliminary injunction. Before therapy, his behavior problems included “outbursts, extreme aggression, kicking, biting and scratching himself, poor eye contact, extreme irritability, hyperactivity, incessant screaming, frequent tantrums and isolating himself from others,” according to testimony given by his mother, Iliana Garrido.

After a month of therapy, she said he had “changed very much,” and was smiling, sleeping better, being less aggressive and more sociable. She also testified he was “learning how to communicate,” that he “says hello to people” and “can say words and sentences.”

Reference: as seen on http://www.theledger.com/article/20120327/NEWS/120329396?p=1&tc=pg

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