ABA is an evidence based treatment that helps children with ASD develop the basic skills (social, behavioral, communicative, self-help, and daily living) that they need to function effectively at home and in the community. The lawsuit alleged that DHS failed to provide the full scope of ABA, focusing only on correcting inappropriate behaviors and not addressing skill deficits, used inappropriate medical necessity guidelines, failed to offer providers who had training in ABA, and failed to allow many qualified ABA providers to enroll in the Medical Assistance program, leaving children without adequate access to this critical evidenced based service.
The Settlement requires DHS to develop new medical necessity guidelines for ABA, promulgate regulations in the summer of 2017 defining the qualifications required of ABA practitioners, require behavioral health managed care organizations to identify practitioners who are currently qualified to provide ABA and seek out-of-network providers if they do not currently have the capacity to provide ABA, allow all qualified ABA providers to enroll in the Medical Assistance program, develop a bulletin explaining that ABA can be used to address skill building for activities of daily living, as well as appoint a person within DHS to receive complaints from families who feel they are not receiving medically necessary ABA based on the terms of the settlement.
“If implemented properly,” said Rachel Mann, attorney for the class, “thousands of Pennsylvania children with Autism Spectrum Disorder will have real access to the evidence based treatment of Applied Behavioral Analysis.”
A copy of the Settlement Agreement can be found by clicking here.
The Disability Rights Pennsylvania (DRP) is the statewide protection and advocacy agency for Pennsylvanians with disabilities. DRP protects and advocates for the rights of people with disabilities so that they may live the lives they choose, free from abuse, neglect, discrimination, and segregation.