Already facing sharp criticism over policies that have resulted in the rationing of care to severely disabled children, Florida healthcare regulators are challenging a federal judges order that the state provide a costly but potentially life-changing treatment to children with autism.
Last spring, U.S. District Judge Joan Lenard struck down the states refusal to pay for applied behavior analysis (ABA) for autistic children, calling the states policy arbitrary, capricious and unreasonable.
The court case involved three autistic youngsters then-5-year-old K.G., 2-year-old I.G. and 4-year-old C.C. whose efforts to obtain behavioral therapy had been denied by the states Medicaid insurance program for needy and disabled people. Lenard ordered that the three children be given the care they sought and that the state provide such care to other autistic children, as well.
The state Agency for Health Care Administration has appealed the order, and, in a pleading submitted in November, argued that the ruling strips the state of its ability to weigh requests for the therapy on a case-by-case basis to ensure the treatments are medically necessary.
There is no evidentiary support for the district courts conclusion that [behavior analysis] services are medically necessary for all autistic Medicaid recipients under 21, the brief said. In fact, the evidence established that ABA treatment is not medically necessary, or even effective, in all cases. Some children do not respond to ABA treatment at all, and, in all other cases, the efficacy of ABA treatment diminishes rapidly after early age.
Autism, typically diagnosed around age 2, is one of the most common developmental disabilities, afflicting about one in 88 children, according to the U.S. Centers for Disease Control and Prevention.
The neurological disorder often affects a childs ability to speak, learn and interact with others.
In her March order, Lenard described as outrageous AHCAs position that the behavioral therapy is not widely accepted by experts in the field. Though AHCA had for years refused to pay for the treatment for impoverished families, state law already requires commercial carriers to provide it to Floridians with private insurance meaning children from poor families were being denied services to which more-affluent families had access.
Behavioral analysis is designed to improve the behavior, language and cognitive development of autistic children so they can lead more-normal lives.
It is imperative, the Miami judge wrote, that autistic children in Florida receive [behavior therapy] immediately to prevent irreversible harm to these childrens health and development.
The rest is here:
State appeals order to pay for special autism treatment