Or How about this:
Court: N.J. wrong to deny therapy for autistic children
Home News Tribune Online 01/21/07By MICHAEL RISPOLI
GANNETT STATE BUREAU TRENTON New Jersey was wrong in denying access to
necessary medical therapy for autistic children whose parents are covered under
the State Health Benefits Program, a state appeals court has ruled.
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Occupational, speech and physical therapy, viewed as standard treatment for the
one in 166 children nationwide affected by autism spectrum disorders, did not
fall under the program provided by the State Health Benefits Commission, which
said coverage cannot be extended "to promote development beyond any level of
function previously demonstrated." In other words, because the boys could not
previously perform the skills taught in these therapies, the program would not
pay for them. A 1999 state law, however, requires coverage parity in medical
insurance, meaning state medical coverage for those affected by biologically
based mental illnesses must be the same for any other covered sickness. The two
rulings Wednesday struck down previous court decisions in finding the
medical-parity act was intended to cover such therapies. Art Ball, director
of government affairs at the Center for Outreach and Services for the Autism
Community, said his organization has fought for this
cause a long time. "The Legislature intended that these kids should get
services, and they didn't intend to create systems by which the state would
deny these services," said Ball. The state's Treasury Department, which
oversees the benefits program, is reviewing the ruling and assessing the impact
it will have on the State Health Benefits Program, said treasury spokesman Mark
Perkiss, who added it is too soon to determine if the department will appeal
the ruling. Prior to denying coverage, Horizon, the benefits administrator
for the state program, actually covered one of the child's therapy for 22
months. According to court documents, the commission's decision to exclude this
type of coverage "occurred after a rise in such claims had been recognized by
Horizon's medical director." "Insurance needs to be based on what people need
and what they are eligible for, not figuring out what you can run your business
on and deny people and get away with it," said Emmett
Ewyer, director of litigation for New Jersey Protection and Advocacy Inc.
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