Victory against Group Health invalidating Neurodevelopmental therapy exclusions!

WAAA new logo-signatureWashington Autism Alliance and advocacy hails United States District Judge, Honorable Robert Lasnik’s order on Friday June 1st, 2012, granting a permanent injunction against Group Health Cooperative of Washington, invalidating the long standing practice of excluding Neurodevelopmental (i.e. Speech, Occupational and Physical) therapies for children over 6 years old in their ERISA plans!

ERISA plans are those regulated by the federal government and apply to all large, self-funded, benefits that are managed by Group Health Cooperative of Washington.  For far too long Health insurance carriers in Washington have been imposing very unreasonable caps, limitations and exclusions to neurodevelopmental therapies for children with conditions listed in the Diagnostic and Statistical Manual of Mental Disorders (current version DSMIV) who are also diagnosed with autism and other developmental disabilities.  In addition, the therapies were not covered at all for individuals over the age of 6, even if medically necessary.

Washington Autism Alliance & Advocacy is committed to removing barriers to insurance coverage of medically necessary treatments for autism spectrum disorders and related developmental disabilities throughout Washington state.

The court also certified the lawsuit as an injunctive relief class:

“…the Court ORDERS Defendants to immediately cease denying coverage for medically necessary neurodevelopmental therapy to treat insureds with DSM-IV-TR mental health conditions simply because an insured is over six years old. Defendants must immediately cease their application of any treatment limitations that are not generally “imposed on coverage for medical and surgical services.”

Z.D. v. Group Health Cooperative, et. al. Order (signed) Granting Pls.’ Mot. for Summ. J.

Please help distribute this press release to your networks throughout Washington State.  We need your help to educate the public on their children’s right to basic healthcare for their children’s DSM conditions.

Help with insurance, Medicaid, education and social services:

For timely reply post confidential insurance /Medicaid questions to:
Family Support Network on Facebook:







Safety in numbers, connect your networks towards greater stability

As drivers become more accustomed to seeing walkers and cyclists on the road, they become more attentive and cautious overall. Instead of “get out of the way” campaigns, we now see messages like “THINK, Slow Down!” or “Kill your Speed, Not a Child”, that place the onus on drivers to increase their awareness of walkers and cyclists.

Research suggest doubling the number of cyclists on the road tends to bring about a 1/3 drop in the per-cyclist frequency of a crash with a motor vehicle. By the same token, tripling the rate of cycling cuts the crash rate in half.


With that in mind…think of crashes as Health Insurance Benefits’ Denials!


Families, physicians and therapists have “CRASHED”so often in trying to get services covered for a patient with autism that they now don’t even bother to try! Clinical amelioration of adverse neurological, sensory or physical impact of a brain disorder is no different than clinical amelioration of adverse impact diabetes or Leukemia.


Please don’t get out of the road!  Please don’t get discouraged! Connect your networks with ours, double & triple our effective advocacy towards improved access to effective medical and educational services for our loved ones with ASD’s.


Here’s how can you help?

  1. Call or write to everyone YOU know in your community and ask them to join our grassroots advocacy coalition.  Let them know connected & tripled in size, we can better avoid “crashes” with private insurance, Medicaid and schools!
  2. Join us on Facebook, meet families, professionals and self-advocates online, share resources, exchange ideas, or ask for help!
  3. Scroll through our online resources for families, download and share with others!


There’s safety in numbers!  Let’s connect our networks towards greater stability for our loved ones’ future here in Washington state.



Arzu Forough






Insurance Update

Specialized Behavior therapies (including Applied Behavior Analysis) and neurodevelopmental therapies are “mental health services” designed to treat autism, a DSM (Diagnostic and Statistical Manual of Mental Disorders) category.  Under Mental Health Parity, blanket insurance policy exclusion for services, therapies and supplies (as well as unreasonable caps) related to the treatment of autism spectrum disorders violates Mental Health Parity laws.

Summary of MHP cases 102213 Please contact ehamburger@sylaw.comor call 206-223-0303 for status of these cases.  

If your children’s therapies are unreasonably capped or they have no benefits for treatments of autism, WAAA can help.  Contact 425.894.7231 or  Please indicate whether your child is covered through private insurance or medicaid.  Washington Autism Alliance & Advocacy is committed to ensure timely access to medical benefits designed to treat autism for all children in Washington.”


Washington’s Network Adequacy Statute and Rules require health plans to ensure that enrollees are entitled to sufficient, timely and appropriate health care services and choice among health care providers (this includes behavior therapies). In articular, the statute requires that “[e]ach carrier must provide for appropriate and timely referral of enrollees to a choice of specialists within the plan if specialty care is warranted(such as Applied Behavior Analysis).

If the type of medical specialist needed for a specific condition is not represented on the specialty panel, enrollees must have access to nonparticipating specialty health care providers.Health carriers are required to maintain adequate networks of providers in order to ensure that health plan enrollees can obtain treatment in their local communities without undue delay, traveling onerous distances or incurring additional out-of-pocket expenses:

An example of “reasonable proximity” is provided in the regulations through the Office of Insurance Commissioner:

“For example, a carrier should not require travel of thirty miles or more when a provider who meets carrier standards is available for inclusion in the network and practices within five miles of enrollees.”

The court is asked not to permit health carriers (Washington State Health Care Authority-HCA) to work around the Court’s Order by imposing a new condition of participating in a research study, for coverage of ABA therapy for autism.

Washington’s Mental Health Parity Act and its Network Adequacy statutes and regulations prohibit HCA’s conditions.

Stephanie Marquis, spokeswoman for the insurance commissioner, has said: “We’re working on a regulation that addresses the issues the courts have ruled on so far that will ensure consumers get the coverage they’re entitled to and insurers understand what they’re required to cover. “The draft language should be ready by the end of the year, she said.

In the meanwhile if any individual with ASD’s has been denied coverage for neuro-developmental therapy (speech, physical therapy, occupational therapy, sensory-motor, neuropsychological evaluation etc.),  behavioral therapy (including Applied Behavioral Analysis therapy) or mental health therapy based upon exclusions or limitations in their Washington state insurance policies, please contact WAAA,  425-894-7231 or

Autism insurance coverage, family-by-family, plan-by-plan and state-by-state

The 6th Annual Autism Law Summit, dedicated to the passage, implementation and enforcement of meaningful autism insurance reform across the nation convened last week at the University of Utah’s Susan J. Quinney School of Law. Lorri Unumb, Autism Speaks VP of State Government Affairs, facilitated the Summit, as she has for the past six years.

The Summit has evolved from an informal gathering of a handful of national advocates, to a capacity-level event from 33 states. Once again, parents, providers, attorneys legislators and regulators, create remarkable momentum in the effort to create a system where individuals diagnosed with an ASD can access coverage for the life-changing treatments they need.

The “Speak out” award to Lou Melgarejo, producer of the “Fixing” Autism video in honor of his daughter Bianca and the difficulties faced by families in gaining insurance coverage for needed therapies set the stage for the jam packed summit.

Utah Representative Merlynn Newbold and Professor Bonnie Mitchell from the S.J. Quinney College of Law, welcomed attendees prior to Lorri Unumb’s presentation,” Autism Insurance Reform Across America.” Five states that passed legislation since the previous Summit: Arkansas, Virginia, West Virginia, Rhode Island and California received honorable mention.

MI State Representative Jason Grill presented “Politics 101” relating lessons learned from his experience in the Missouri legislature’s passage of autism insurance reform.

Bryan Davey, PhD, BCBA-D (AZ) and Colleen Allen, PhD, CCC/SLP (MI); employer representatives Doug Green of DTE Energy (MI) and Jeremy Shane of HealthCentral(MD) and parent advocate Karen Fessel, Dr. PH(CA) presented “Convincing Self-Funded Companies to Add an Autism Benefit.”

Misty Bloom, JD of the Behavior Analyst Certification Board(FL); Andrea Chait, PhD, BCBA-D, NCSP (RI), and Jill McLaury, MS BCBA (WV) gave an overview of the provider credentialing issues.

I joined attorneys Ele Hamburger (WA), Dan Unumb (SC) and Dave Honigman (MI) for an update on litigation efforts against insurers.

Billy Edwards, MS, BCBA (TX); Mike Wasmer (KS), and Amy Weinstock (MA) shared their experiences implementing autism insurance laws in their respective states.

Adam Cole, JD, General Counsel, CA Department of Insurance; and Angela Nelson, Director of Consumer Affairs, and Melissa Palmer, Legislative Director, from the MI Department of Insurance and Jacqueline Eckert, MedClaims Liaison (PA) discussed “Enforcement of Coverage”.

A mock legislative hearing on autism insurance reform, provided an opportunity for attendees to experience first-hand the challenges frequently experienced by advocates.

Insights by the Autism Speaks Government Relations team specific to grassroots development, communications, policy, implementation and enforcement was interspersed throughout the summit.

As all of us headed back home to different parts of the country, colleagues, old and new shared smiles and hugs of encouragement. Once again, the connection of hope and ideas has been sparked and 2012 is destined to be another year of hard-fought progress in the effort to ensure access to autism insurance coverage, family-by-family, plan-by-plan and state-by-state.


Shayan’s Law Update

Full Mental Health Parity passed in Washington state in 2005.  It was phased in over 5 years and all state regulated plans renewing after 7/1/2010 are legally obligated to  cover medically necessary treatments for individuals with a DSM diagnosis for life, with the same dollar cap as medical & surgical benefits. WA MHP is only applicable to plans regulated by WA state laws, fully funded plans and Public Employees Benefits.

Shayan’s Law was brought forward because insurance companies have not been following the letter and spirit of this law for individuals with autism.  This has prompted legal experts to look into this very closely.  Based on the information available to us:

  1. Diagnosis and treatment should be covered if referrals (prescribed testing and treatment) came from a licensed physician or licensed psychologist.
  2. Treatment should be provided by a licensed therapist.
  3. Unlicensed providers (i.e. nationally certified behavior specialists and behavior therapy assistants) must become licensed through Washington State department of health.

Navigating this system can be difficult, for help with the process visit:

We are awaiting the outcome of court cases testing Mental Health Parity and depending on the outcome have to be prepared to block any action that will limit protection under Mental Health Parity for those with autism.   If you have any questions, concerns or comments, please post to the link above.

All my best,

Arzu Forough

Shayan’s Law-Autism Insurance Parity-Hearing update

Many thanks to all the families and advocates who packed the hearing room yesterday, dressed in red and carrying pictures of their children or accompanied with their children.

Our hearing was well orchastrated.   Lorri Unumb(Autism Speaks Senior Policy Advisor), Dr’s Bryan King and Gary Stobbe (Seattle Children’s Hospital Autism Center), Kathy George (Harrison, Benis & Spence attorney), Arzu Forough (Washington Autism Alliance & Advocacy) and Chanel Krueger (highly accomplished, articulate young lady with autism) were among those who provided testimony is support of Shayan’s Law, Autism Insurance Parity (AIP). (The hearing can be viewed through TVW archives by clicking here).

The fiscal calculations on the state of WA to cover the public employee’s dependents  was grossly inflated ($141,773,139), so much so that several committee members requested a revised fiscal data from the office of Financial Management (OFM).

The Senate committee members were clearly in favor of Shayan’s Law.  Our next steps is two fold,  provide true cost impact  data from states that have had AIP for over a decade AND to continue to build the momentum of support.

Here’s How YOU Can Help:

1.Call and write all members of the committee (click on text for contact info.) and let them know Washington state can’t afford to bear the cost of autism alone, let them know how much your family (and/or local school district) ia spending on your loved one with autism(on specialized developmental, behavioral and education programs).

2. Multiply your efforts, forward this note to teachers, therapists, friends, any and all supporters and ask them to please get actively involved.

3.Volunteer with us (click here to view volunteering opportunities)

Thank you for your consideration.

Washington Autism Alliance and Advocacy Coalition

To receive updates about Shayan’s Law please register:


To post questions, comments, inquiries visit:

Please call your senator to cosponsor Autism Insurance Parity (Shayan’s Law)!

WAA Coaltion members,

Give a loved one with autism 5 minutes, call your senator and ask them to end autism insurance discrimination by signing on as a cosponsor to Shayan’s Law, Autism Insurance Parity(AIP).

1.     Call your own district’s senator (click here to find their contact information)

If your not sure what to say try this:

“My name is _________ and I’m your constituent.  I am calling to ask Senator______to cosponsor Shayan’s Law (SB5059)-Autism Insurance Parity (Prime Sponsor Sen. Ed. Murray).  Shayan’s law requires private insurance coverage of autism under Washington’s Mental Health Parity.  Individuals with autism are entitled to the full coverage that Mental Health Parity offers.  23 other states have already passed laws that require private insurance to cover autism diagnosis and medically necessary treatments.  This is an extremely important bill for our family and critical to helping my child/grandchild/neice/nephew/other gain access to appropriate health care benefits. Thank you so much for your consideration.  Please let me know when Senator______ has signed on as a cosponsor.”

If they have any questions please refer them to Senator Ed. Murray’s office.

2.     Multiply your efforts! Forward this note to everyone who supports individuals with autism (teachers, therapists, family, coworkers, other community members) and ask them to:

Thank you in advance for your calls.


Autism Legislative Work session very promising! Please thank members…

The House Human Services Committee examined the current strategies and best practices for diagnosis, availability and  attainability of services for persons with autism on June 16th.

It was very clear that the members of the committee had heard from their constituents on the overwhelming unmet needs of your loved ones with autism.

Chairwoman Dickerson requested specific recommendations from the Department of Health member on the panel, who informed them none would be forthcoming.  The paenl and Chairwoman Dickerson shared their disappointment with the Department of Health attorneys present for their lack of direction to the legislature on the legislative actions needed.

In attendance, Sue Elliott, Executive Director of the ARC of Washington, pledged her strong support to work with the Autism community towards addressing top priorities and needs in the 2011 legislative session.

Please see contact information for the committee members in attendance as well as contact information for Sue Elliott, Executive Director of the ARC of Washington.  Please take a couple of minutes to write to the Representatives as well as Ms. Elliott for thier interest in helping prepare WA to face autism more effectively.

Committee Members in attendance:

Representative e-mail Phone
Dickerson, Mary Lou (D) Chair – 36th (206) 545-6513
Orwall, Tina (D) Vice Chair – 33rd (206) 824-5097
Darneille, Jeannie (D) – 27th Representative Jeannie Darneille (360) 786-7974
Green, Tami (D) – 28th (253) 534-3231
Herrera, Jaime (R) – 18th (very briefly) (360) 687-0489
O’Brien, Al (D) – 1st (360) 786-7928
Sue Elliott, Executive Director ARC of Washington

Thank you very much for your continued support.

With regards,

Arzu Forough

Washington Autism Advocacy Coalition