From the Disability Rights Network of Pennsylvania:
The Disability Rights Network of Pennsylvania (DRN) recently settled Sonny O. v. Dallas, a class action lawsuit under Title XIX of the Social Security Act against the Commonwealth’s Department of Human Services (DHS) on behalf of a class of Medical Assistance-enrolled children with Autism Spectrum Disorder (ASD) who have requested or will in the future request Applied Behavioral Analysis (ABA). Plaintiffs alleged that DHS was not providing the full scope of ABA, used inappropriate medical necessity guidelines, failed to offer providers who had training in ABA, and failed to allow many qualified ABA providers to enroll in the MA program, leaving children without access to this critical evidenced based service.
Among its major provisions, the settlement requires DHS to develop new medically necessity guidelines for ABA to be provided through its behavioral health rehabilitation services system, promulgate regulations within eighteen months defining the qualifications required of ABA practitioners, require behavioral health managed care organizations to identify practitioners who are currently qualified to provide ABA and seek out-of-network providers if they do not currently have the capacity to provide ABA, develop a bulletin explaining that ABA can be used to address skill building for activities of daily living (toileting, brushing teeth, etc.) as well as appoint a person within DHS to receive complaints from families who feel they are not receiving medically necessary ABA based on the terms of the settlement. Click here for a more detailed summary of the settlement’s major provisions. Click here to view an important exhibit.
A formal notice will be sent to family members of the class in the near future, affording them the opportunity to write to the Court or attend a hearing at which the Court will decide whether to approve the class action settlement.
Disability Rights Network of Pennsylvania
Offices in Harrisburg, Philadelphia, and Pittsburgh