[Note: Shared for #AutisticHistory archive purposes. This is NOT An Autistic Ally.]
Licensing Struck Down As Basis For ABA Denials in California
April 25, 2014
(April 25, 2014) — Demanding that providers of applied behavior analysis (ABA) hold a state license cannot be used to deny insurance coverage of medically necessary treatment for autism, a California appeals court has ruled, citing the state’s 2011 autism insurance reform law as its basis.
In addition, the court found that licensing also cannot be used to deny ABA claims filed by members of the state employees health plan (CalPERS), which was not covered under SB.946, the Calfornia autism insurance law. The Autism Speaks Legal Resource Center filed a friend-of-the-court brief in the case, which was brought by Consumer Watchdog against the state Department of Managed Health Care (DMHC).
“Californians now finally have a definitive statement from the court that state regulators cannot allow health insurers to discriminate against autistic children merely because treatment providers do not possess a state license,” said Fredric D. Woocher of Strumwasser & Woocher LLP, lead attorney in the case.
“Families of firefighters, school employees and others covered by CalPERS-sponsored health plans will now be able to secure coverage for critical and effective treatment for autism,” he added. “Health insurers can no longer deny coverage on the pretext that a treatment provider does not hold a state license, a practice which has been conclusively held to be illegal.”
The licensing issue has been raised in a host of states following the enactment of autism insurance reform laws. Implementation of New York state’s 2011 law was delayed for months until lawmakers addressed the issue through new legislation.
“While there can be no doubt that the treatment plan for providing ABA to any autistic child must be established, modified, and supervised by a qualified expert in ABA, the evidence in this case indicates that the actual delivery of services to the child may be performed by a non-expert,” wrote Associate Justice Patti Kitching in the majority opinion.
“It appears that ABA, and similar behavior therapies, are somewhat unique among medical treatments in this respect,” the court found. “While the treatment plan must be created, modified, and supervised by a professional, a paraprofessional may actually deliver the services.”
Autism Speaks argued that unlicensed providers delivered care for years in California abiding by national standards and with no objection from the state, specifically citing the Regional Centers. “As reflected by SB946, the Legislature has concluded that BCBAs are appropriate and necessary providers to meet these healthcare needs,” according to the brief, which was prepared by Dan Unumb, executive director of the Legal Resource Center.
Consumer Watchdog originally brought the case in 2009, arguing that health plans were obligated to cover ABA for autism when prescribed as a medically necessary treatment. DMHC countered that it could not under state law require health plans to cover ABA services provided by unlicensed providers, even if they were certified by the national Behavior Analyst Certification Board.
The appeals court found that the licensing issue was resolved by SB.946, the 2011 law, which clearly stated BACB certification would be sufficient for services to qualify for coverage. SB.946, however, exempted Medi-Cal, the Healthy Families Program and CalPERS. (Healthy Families was subsequently discontinued with beneficiaries transferred into Medi-Cal.)
The appeals court said DMHC could not use licensure as a reason to deny claims filed by CalPERS members.
“We stress that we are not concluding that the health plans exempted from the ABA statute are, in fact, subject to its terms,” the appeals court ruled. “The ABA statute does not require these plans to provide ABA; we do not require them to do so, either. We simply hold that DMHC’s practice of upholding denials of coverage on the basis that BACB‑certified therapists are unlicensed is no longer legally justified.”
However, the appeals court noted that CalPERS was still obligated to cover “basic health care services” as well as “medically necessary treatment of severe mental illnesses” under existing California law, such as its Mental Health Parity Act. Medi-Cal, on the other hand, is not covered under the Mental Health Parity Act.
The Autism Community Is Not The Autistic Community
Autistic people have fought the inclusion of ABA in therapy for us since before Autism Speaks, and other non-Autistic-led autism organizations, started lobbying legislation to get it covered by insurances and Medicaid.
ABA is a myth originally sold to parents that it would keep their Autistic child out of an institution. Today, parents are told that with early intervention therapy their child will either be less Autistic or no longer Autistic by elementary school, and can be mainstreamed in typical education classes. ABA is very expensive to pay out of pocket. Essentially, Autism Speaks has justified the big price tag up front will offset the overall burden on resources for an Autistic’s lifetime. The recommendation for this therapy is 40 hours a week for children and toddlers.
The original study that showed the success rate of ABA to be at 50% has never been replicated. In fact, the study of ABA by United States Department of Defense was denounced as a failure. Not just once, but multiple times. Simply stated: ABA doesn’t work. In study after repeated study: ABA (conversion therapy) doesn’t work.
What more recent studies do show: Autistics who experienced ABA therapy are at high risk to develop PTSD and other lifelong trauma-related conditions. Historically, the autism organizations promoting ABA as a cure or solution have silenced Autistic advocates’ opposition. ABA is also known as gay conversion therapy.
The ‘cure’ for Autistics not born yet is the prevention of birth.
The ‘cure’ is a choice to terminate a pregnancy based on ‘autism risk.’ The cure is abortion. This is the same ‘cure’ society has for Down Syndrome.
This is eugenics 2021. Instead of killing Autistics and disabled children in gas chambers or ‘mercy killings’ like in Aktion T4, it’ll happen at the doctor’s office, quietly, one Autistic baby at a time. Different approaches yes, but still eugenics and the extinction of an entire minority group of people.
Fact: You can’t cure Autistics from being Autistic.
Fact: You can’t recover an Autistic from being Autistic.
Fact: You can groom an Autistic to mask and hide their traits. Somewhat. … however, this comes at the expense of the Autistic child, promotes Autistic Burnout (this should not be confused with typical burnout, Autistic Burnout can kill Autistics), and places the Autistic child at high risk for PTSD and other lifelong trauma-related conditions.
[Note: Autism is NOT a disease, but a neurodevelopmental difference and disability.]
Fact: Vaccines Do Not Cause Autism.