Military families with autistic children file lawsuit against DoD for refusing coverage for ABA therapy

Military families having children with autism have filed a class action lawsuit against the Department of Defense, alleging that the DoD and its health benefits division, TRICARE, have wrongfully refused to provide insurance coverage for applied behavior analysis (ABA) therapy.  In a dramatic new development, the Department of Defense has vacated its prior policy of denying payment for ABA therapy for autistic children of military families, but it is still refusing to pay for such claims.  Specifically, the DoD's attorneys have issued a policy letter stating, "The TRICARE Management Activity has vacated any previous instruction it may have issued to its contractors that ABA is not covered under the Basic Program."  Military families having an autistic child should file claims for ABA therapy without delay.

ABA therapy is known to be extremely effective in treating children with autism if given at an early stage of development.  It is scientifically validated and includes positive reinforcements and individual goal setting,  to achieve dramatic behavior modification.  ABA therapy allows children with autism the opportunity to reach maximum potential and the hope of becoming independent in their adult lives.  Yet, the DoD refuses to afford this therapy to autistic children of military families.

The lawsuit contends that the military health benefits division, TRICARE, at the direction of the DoD, incorrectly characterizes ABA therapy as "special education" and thereby improperly excludes ABA therapy from the health care available to members of the military. The families refute this position and demonstrate in their Complaint that many prestigious individuals and organizations, including the United States Army, the Army and Marine Corps Autism Task Force, the Executive Director of the National Autism Center, the Acting Surgeon General of the United States Army, and United States Air Force Major Ella B. Kundu, Diplomate of the American Board of Psychiatry and Neurology, agree that ABA therapy is not "special education."

The case is Berge v. United States of America, et al, No. 10-cv-00373-RBW (DC), and it was assigned to Judge Reggie B. Walton of the federal district court in Washington, D.C.

The Department of Defense has recently requested that all action on the case be stayed and that the matter be remanded, or sent back, so that the DoD can study the issue further.  The families have vigorously opposed the request for a stay or a remand, contending that time is of the essence for the approximately 20,000 military children with autism.  Counsel for the families assert that the DoD's policy of denying such care to autistic children of military families is illegal and should be invalidated without delay.

Gerard Mantese, co-counsel for the families, stated: "The thousands of military families that we represent deserve health care coverage comparable to what is being offered by private insurers.  These military families give us so much to be thankful for in this country – our freedom and our safety.  Our military should not also be asked to sacrifice proper health care for their children in order to serve their country."

Former Michigan State Senator, David Honigman, co-counsel for the families, emphasized: "There is only a small window of opportunity for these children to receive this therapy and obtain maximum benefit from it.  The studies show that this therapy yields the most dramatic improvement in abilities if administered at early ages.  We oppose any attempt to delay this case because children with autism will suffer during the delay.  The DoD's denial of coverage based on the assertion that ABA therapy is 'special education' is contrary to the plain meaning of the health benefits statute and is incorrect as a matter of law."

Source:

Mantese Honigman Rossman and Williamson, P.C.

Comments

  1. Carmen Allen Carmen Allen United States says:

    ABA therapy is the very cause of the recent hearings on restraint and seclusion and people are fooled into thinking this is the majic bullet.  There is no such thing and experimenation (Behaviorism) is even less of an answer for these children.  Please show me that adults with Autism who say they have been put through the therapy and it works.  Not the parents but the actual patients. No wonder adults with Autism have a high unemployment rate.  If you had ABA by control freaks  - anyone would be scared to go out in public and work...

    Shame on those supporting a therapy that does not work with everyone and more importantly has led to the abuse of children.  

  2. Daniel Daniel United States says:

    ABA is NOT a therapy. It is a teaching method in which things are broken down into small "items" and taught one piece at a time.

    In the ME Book, Lovaas wrote that only non-professionals should be used as "therapists" and at the time he claimed he had 47% success rate.

    Now, Lovaas claims that the "therapists" must have a license and some BCBA degree. since the "therapists" have been licensed, there is NOT 47% success rate, not even 4% or 1%., which leads one to question whether 47% had even happened. in addition - the "therapist" used to cost 8-10 dollars per hour. now it is suddenly very expensive. there is no reason why something so simple that high school students can do would become expensive after it was decided to say that they must be licensed. the parents can hire some local high school students and pay $20 an hour.

  3. Alan Cartwright Alan Cartwright United States says:

    With all due respects to other two commentors, ABA therapy works and works well. I cannot account for the opinions of the other two commentors about ABA but respect them for what must have been a tragic experience - most likely in a school setting where inexperienced or untrained therapists were used. ABA has been proven effective clinically. It has worked wonders for my daughter. She was non verbal and diagnosed with ASD and global developmental delay when she was 2.5 years of age and today at seven, with 5 years of ABA behind her, she is in typical kindergarden at the head of her class in reading, spelling and math. She still has some autistic behavior to be sure but we are working on those behaviors with her ABA therapists and BCBA. Her therapy is done in our home so we have total control over the program. Is ABA a magic bullet? It may not have been a magic bullet but it sure was a golden bullet for our daughter.

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