For More Information Contact:
Doug Porter, Director, HCA 360-725-1040
Eleanor Hamburger or Rick Spoonemore,
Sirianni Youtz Spoonemore: 206-223-0303
Public Employees Enrolled in the Uniform Medical Plan
Will Receive Coverage of Applied Behavior Analysis Therapy
Partial Settlement Provides for Coverage of
Behavioral Therapy for Autism
Seattle, WA – The Washington State Health Care Authority and a Class of Public Employee Benefits members with autism have reached a partial settlement in a lawsuit seeking coverage of applied behavior analysis (ABA) therapy to treat autism and autism spectrum disorders under the state’s Uniform Medical Plan.
The settlement was filed on July 16, 2012, in King County Superior Court with Judge Susan Craighead. The case is D.F. et al., v. Washington State Health Care Authority et al., No. 10-2-29400-7 SEA. The settlement is called “Shayan’s Settlement” after one of the named plaintiffs, according to Sirianni Youtz Spoonemore, counsel for the plaintiffs.
The new autism benefit will provide coverage for ABA therapy when recommended by an autism expert to address an enrollee’s behaviors that have an impact on development, communication or adjustment. Coverage will include the provision of ABA therapy in natural setting such as a child’s home or community by therapy assistants working under the supervision of licensed providers.
For years, autism advocacy groups have lobbied the Washington State Legislature to pass legislation that would mandate insurance coverage for ABA therapy and other services to treat autism. The legislation was known as “Shayan’s Law.” The insurance industry opposed the legislation, arguing that autism benefits were already covered under Washington’s Mental Health Parity Act. When their legislative efforts did not succeed, Shayan and his parents, along with other parents and their autistic children, sued for coverage.
“This settlement achieves what we tried to do at the legislature with ‘Shayan’s Law,’” said Arzu Forough, parent of two named plaintiffs and Chief Executive Officer of Washington Autism Alliance & Advocacy. “This is a watershed moment for Washington families with autism. With HCA’s leadership, we are entering a new era of full coverage for persons with autism.”
“Many of us have a relative, or know a friend or acquaintance, who suffers from an autism spectrum disorder. I do myself,” said Doug Porter, Director of the Health Care Authority. “In some cases, the symptoms are so severe that families are faced with desperate choices, like leaving the workforce to stay home and care for a child, forgoing needed services because they can't afford to pay, or moving out of state to find the resources they need. We are encouraged to know that this settlement will help families in Washington and elsewhere get the relief they need.”
The class action against HCA is one of six pending class action lawsuits over Washington insurers’ limitations or exclusions of neurodevelopmental and behavioral therapies, including lawsuits against Premera Blue Cross, Regence Blue Shield, and Group Health Cooperative.
“We are pleased to work hand-in-hand with HCA to develop a new ABA therapy benefit,” said Susan Murdoch, another parent whose 8-year-old son was also a named plaintiff. “This agreement is a giant step forward. Now UMP enrollees with autism can have effective therapy, regardless of their family’s ability to pay out of pocket.”
UMP members with autism will now have more treatment options, and will not have to worry about their family’s ability to pay out of pocket. The settlement only addresses prospective or future coverage of ABA therapy. Whether HCA will have to pay for class members’ out-of-pocket expenses for ABA therapy received in the past will be decided in a later “damages” phase of the litigation.
“The Mental Health Parity Act promised that services to persons with mental conditions, including autism, would be covered at parity with medical and surgical services,” said Eleanor Hamburger of Sirianni Youtz Spoonemore. “This settlement fulfills that promise.”
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