The Miami Herald reports:
A federal appeals court has upheld a ruling that impoverished Florida children with autism cannot be denied a costly but proven treatment that can help them lead more productive lives.
The 11th U.S. Circuit Court of Appeal in Atlanta has ruled that U.S. District Judge Joan Lenard of Miami was justified when she ordered the state Agency for Health Care Administration to pay for the treatment. Lenard’s ruling could affect thousands of Florida children who have the often-debilitating neurological disorder, enabling them to receive what is called applied behavior analysis, an intensive treatment that can help autistic children speak and function at a higher level.
Autism Speaks reports:
The decision by the 11th Circuit U.S. Court of Appeals was hailed as a victory by the Autism Speaks Legal Resource Center, which intervened on behalf of the plaintiffs, three children diagnosed with autism, against the Florida Agency for Health Care Administration (AHCA), which administers the state's Medicaid program. The plaintiffs had sued the state in 2011, contesting its blanket denial of ABA coverage on the basis the therapy was "experimental."
In a strongly worded opinion, U.S. District Court Judge Joan Lenard in March 2012 ordered the state to cover ABA, asking, "How many children were lost?" as a result of the state's denials.
The appeals court, however, did remand the case to Lenard to clarify that AHCA retains the authority to determine the medical necessity for ABA coverage on a case-by-case basis. The appeals court noted that AHCA in its appeal had dropped its claims that ABA was experimental, but was concerned Lenard's order could be misinterpreted to require blanket coverage of ABA.
Lenard had found that “there exists in the scientific and medical peer-reviewed literature a plethora of meta-analyses, studies and articles that clearly establish ABA as an effective and significant treatment to prevent disability and to restore children to their best possible functional level and restore their developmental skills.”