Providence Can't Exclude Autism Treatments From Coverage, Judge Rules

Providence Health Plan failed to follow federal and state law when it for years refused to cover an intensive form of therapy for autistic children, a U.S. District Court judge ruled today in Portland.

The families of two autistic children filed suit last year after being denied coverage for the therapy, called Applied Behavior Analysis. One family was able to pay out of pocket for treatment, but the other family couldn't afford the costly care.

"We are ecstatic," says Keith Dubanevich, the Portland lawyer who represented the families in this case. "This is a tremendous victory for people with disabilities not just in Oregon but across the country. It clearly says you can't treat autism any differently. It's a significant decision."

The 2013 lawsuit argued that Providence violated federal and state mental health parity laws that require mental disabilities to be covered the same way physical disabilities would be covered. Providence has argued that it doesn't have to cover the treatment because it has a developmental disability exclusion in its policy.

"The plain text of the Federal Parity Act prohibits 'separate treatment limitations that are applicable only with respect to mental health or substance use disorder benefits.' Thus, under the plain text of the statute, Providence's Developmental Disability Exclusion is prohibited," Simon said.

Counsel for Providence could not be reached for comment.

A second case is pending against Oregon's Public Employee Benefit Board, which also has denied coverage of the autism treatment. It's unclear how or when this will affect other companies that also deny that coverage.

WWeek 2015