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Star Tribune

Amy Dawson wins key decision in lawsuit to help low-income children who have autism obtain coverage for therapy. April 7, 2011.

Amy Dawson, founder of the Autism Advocacy and Law Center in Minneapolis, received a favorable decision from the Minnesota District Court, Second District, on Tuesday this week. Dawson represents a 2-year-old autistic child named T.O. who was denied coverage for an intensive type of autism therapy called Applied Behavior Analysis (ABA) or Intensive Early Intervention Behavior Therapy (IEIBT). The lawsuit aims to ensure that low-income children who have autism receive coverage for medically necessary treatment for autism. Dawson offered proof that low-income children who have autism are systematically denied coverage for evidence-based, medically necessary autism therapy by HealthPartners — even while other children enrolled in Medical Assistance routinely receive coverage for the same type of therapy. Ramsey County Judge Robert Awsumb remanded the case to an administrative law judge for clarification on several key issues. [link to decision; link to 4/6/11 Star Tribune article, http://www.startribune.com/lifestyle/wellness/119298354.html
] Dawson feels confident that these further proceedings will lead to winning coverage for her client’s autism therapy and she also hopes that it will end the disparate treatment of low-income children with autism.

HealthPartners, acting as the administrator of T.O.’s MA health benefits, denied coverage for T.O.’s therapy on the grounds that IEIBT is not included in the MA benefit set. The court’s order embraced the proof offered by Dawson that this assertion is belied by the fact that when DHS administers the MA benefit set, IEIBT is routinely covered as a type of “skills training.” Dawson brought suit against HealthPartners and the Minnesota Department of Human Services (DHS) challenging the denial of coverage for IEIBT treatments for 2-year-old T.O. She argued that the state provided MA coverage for ABA/IEIBT treatment for children insured under MA’s “fee-for-service” plans, for which eligibility is based on the child’s disability, but allowed HealthPartners to deny coverage to families enrolled in MA’s pre-paid managed-care programs (MA-PMAP), in which low-income families are enrolled. The practice of not paying for IEIBT treatments under the MA-PMAP effectively deprives low-income children of access to treatments.

Dawson’s suit has prompted Minnesota’s Department of Human Services and the Legislature to take a closer look at the disparity in application of the MA benefit set between low-income children enrolled in MA-PMAP and children who are enrolled in MA on the eligibility basis of “disabled.” She is hoping that this test case will lead to a change in policy that will ensure that all families, regardless of income, are informed of all MA coverage options, as well as the option of ABA/IEIBT treatment for children with autism spectrum disorder, and be given a fair chance to navigate the system to take advantage of the treatment.
Related Story: Star Tribune features shine light on autism treatment debate, and on attorney Amy Dawson’s court battle to end the disparities of how children with autism in Minnesota receive behavioral treatments.
Part 1 – Autism’s $100,000 question, Star Tribune, April 3, 2011, story by Maura Lerner: http://www.startribune.com/lifestyle/wellness/119121174.html

The April 3rd issue of Star Tribune includes the article highlighting the success Amy Dawson’s son Mac has seen with ABA treatment: Intensity, then progress, Star Tribune, April 3, 2011, story by Maura Lerner: http://www.startribune.com/lifestyle/wellness/119121489.html

Part 2 – Autism’s $100,000 question – Kids with autism face double standard, Star Tribune, April 4, 2011, story by Maura Lerner: http://www.startribune.com/lifestyle/wellness/119121669.html

Star Tribune features shine light on effective autism treatment, and on attorney Amy Dawson’s court battle to end inequality for low-income children who have autism.

In a two-part, in-depth series, the Star Tribune delved into the debate over effective treatments for children with autism spectrum disorder and about the state’s inconsistent approach to paying for those treatments for children covered under Medical Assistance. AALC attorney Amy Dawson, is featured along with her son Mac Dawson-Moore, who has benefitted from an intensive type of treatment known as Applied Behavior Analysis (ABA) or Intensive Early Intervention Behavior Therapy (IEIBT). Dawson, the founder of the Autism Advocacy and Law Center, has also represented families experiencing the challenges of obtaining coverage under the state’s Medical Assistance program for these treatments.
Part 1 – Autism’s $100,000 question, Star Tribune, April 3, 2011, story by Maura Lerner: http://www.startribune.com/lifestyle/wellness/119121174.html
The April 3rd issue of Star Tribune includes the article highlighting the success Amy Dawson’s son Mac has seen with ABA treatment: Intensity, then progress, Star Tribune, April 3, 2011, story by Maura Lerner: http://www.startribune.com/lifestyle/wellness/119121489.html

Part 2 – Autism’s $100,000 question – Kids with autism face double standard, Star Tribune, April 4, 2011, story by Maura Lerner: http://www.startribune.com/lifestyle/wellness/119121669.html

Related Story: Amy Dawson wins key decision in lawsuit seeking equitable treatment by state Medical Assistance program of intensive treatment for children with autism. Read Star Tribune article Judge: Minnesota ‘inconsistent’ on autism care, April 6, 2011, story by Maura Lerner: http://www.startribune.com/lifestyle/wellness/119298354.html

Legislature’s Response is to Consider Cutting Coverage for Autism Therapy!

Rep. Abeler (R-Anoka), the powerful chair of the House Health and Human Services Finance Committee is aiming the focus on whether Medical Assistance (MA) should cover medically necessary care for autism. This is particularly scary given that the legislature is looking in every possible place to cut spending.

At the center of Abeler’s concern is coverage for intensive early intervention behavior therapy and applied behavior analysis — but this coverage is tied to a definition in state statute that concerns nearly every type of behavior therapy for autism.

Related Story: Autism Payments are under scrutiny, Star Tribune, April 8, 2011, story by Maura Lerner: http://www.startribune.com/lifestyle/wellness/119445264.html