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A growing number of states are proposing laws that would require insurance companies to pay for autism treatments, thus providing relief to dozens of schools that have been bombarded with lawsuits about services for autistic students in recent years. Last year, Colorado, South Carolina and Texas passed autism insurance laws, and more than two dozen states considered similar legislation. Several lawyers who represent autistic children in legal disputes with school districts are pushing for the legislation, stressing that it could stem the tide of lawsuits that are continuing to pile up against schools. [See related article, " Autism Avalanche."] “This additional insurance coverage, if enacted, clearly would reduce the need for many of these suits. And at the very least, it would reduce the scope of the kind of suits that are being brought today,” said Gary Mayerson of Mayerson & Associates, a New York law firm that deals exclusively with autistic children. Currently, Mayerson’s firm is representing about 200 families tangled in administrative and legal disputes with schools over autism services, such as speech and occupational therapy. Mayerson said the bulk of autism lawsuits involve parents seeking tuition reimbursement from school districts that can’t meet the needs of their children, who have to attend specialized schools. Other lawsuits seek better services and treatments for autistic children, and reimbursement for assessment tests, which run in excess of $5,000. According to Autism Speaks, a national advocacy group, few private insurance companies or other employee benefit plans cover therapies for autism, a brain disorder that inhibits a person’s ability to communicate and develop social relationships, and often includes extreme behavioral challenges. The diagnosis of autism has increased tenfold in the last decade, currently affecting one in 150 children in the United States. Most recently, the 6th U.S. Circuit Court of Appeals on Jan. 7 ruled in favor of a Tennessee school board that had spent more than $2 million defending an autism suit, holding that it provided an autistic boy with an appropriate education, despite his parents claiming otherwise. Deal v. Hamilton County Dept. of Education, No. 06-6214, 2008 WL 77788 (6th Cir.). In Virginia, parents of autistic children won two key lawsuits against local school districts in 2006 when a judge ruled that the public schools had failed to properly educate the children, and ordered them to pay the students’ private tuition. JP, a minor v. Hanover County School Board, No. 3:06cv28 (E.D. Va.); and County School Board of Henrico County v. R.T., a minor, No. 3:04cv923 (E.D. Va.). Legislation no cure-all Areva Martin, an attorney at Los Angeles-based Martin & Martin who is currently handling about 30 autism cases, said insurance companies won’t pay for autism services because they believe they are experimental. She disagrees with that assessment, arguing that autistic children with mental health issues should be afforded the same coverage that a stroke victim gets when speech and occupational therapy is necessary. However, Martin anticipates that legislation mandating insurance coverage of autism will initially increase litigation, because parents will likely start suing insurance companies over issues such as the duration of treatment. For example, a carrier might cover 16 weeks of speech therapy, but the parent will argue the child needs more. “But I’d like to think that over some longer period of time, yes, you might see a decrease in litigation,” Martin said. The health insurance industry, meanwhile, is opposed to legislation mandating coverage for autism, arguing that it would drive up the costs of premiums, forcing consumers to pay for services they might not want, or need. And employers, particularly small ones, may drop coverage altogether due to potentially higher costs. “On principle, we have been as an industry opposed to mandates,” said Mohit Ghose, spokesman for America’s Health Insurance Plans, a trade association representing more than 1,300 health insurance plan providers. “Our members try to do the right thing and provide coverage for what works in the medical arena.”

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