Free & Appropriate Public Education

Securing Funding for Your Child's Program

Under both State and Federal Law, your child is entitled to a Free and Appropriate Public Education (FAPE). Therefore, if it is established that the system of public education available to your child is not "appropriate" for his or her needs, it may be possible to secure funding for an ABA program which may be considered more appropriate to meet the educational needs of your child.

Since Autism encompasses educational delays as well as behavioral aberrations, you may be able to secure partial funding from your school district or local education authority for the educational needs of your child, and partial funding from your local regional center or Medicaid agency for the behavioral needs of your child. Often, education authorities and Medicaid or similar state agencies work out a formula to share the cost of your child's ABA program.

If your child is under the age of three, you will not be eligible to gain funding from your school district. Because of this, you should be able to gain the bulk of your funding from your state Medicaid or Health Department agency. To gain partial or full funding for your child's ABA program from such an agency, you must contact the service coordinating agency in your area (such as a Regional Center) and request that an assessment of your child be conducted. A Medicaid caseworker will be assigned to you and an intake and subsequent multidisciplinary assessment will be arranged. After the assessment an Individual Family Service Plan (IFSP) meeting will be conducted. The purpose of the meeting is to discuss the results of the multidisciplinary assessment and propose goals and objectives. Once goals and objectives are agreed upon, placement and services that will assist your child in meeting those goals will be discussed. At this time you may be offered behavioral services. It is your responsibility to ascertain the level of experience of the vendor offered to you and also to determine if the number of hours you have been offered is appropriate. Therefore, it would be necessary for you to gain the advice of a well-known private ABA professional if you are unsure about the options given to you by the state agency.

If your child is over the age of three, you will be able to gain funding from your local education authority (school district). If your child already qualifies for special education services and has a classroom placement and/or has been receiving special services, you may request a change in services and/or placement. In other words, you may request that the district funds for an ABA program. In order to request such funding, you must ask your district to hold an Individualized Education Plan (IEP) meeting. All such requests should be made in writing. If you are approaching your school district for the first time, they will want to ascertain the eligibility of your child for special education services. An assessment will be scheduled and following the assessment an IEP meeting will be arranged to discuss the results of the evaluation and propose goals and objectives. Once goals and objectives are agreed upon, placement and services will be offered. Once again, if you have questions about the appropriateness of the offer, it would be necessary for you to consult with a private ABA professional who specializes in such treatment. Furthermore, many school districts provide ABA programs themselves and CARD recommends that you observe and evaluate the programs offered by your local education authority as these programs may be able to meet your child's needs.

Another option you may have for funding is your insurance company. If your insurance policy does not exclude Autism as a disorder or Applied Behavior Analysis as a treatment, you may be able to gain some funding for ABA services. Often, insurance companies will only provide funding if the provider is a licensed psychologist or physician.

Individuals with Disabilities Education Act (IDEA)

IDEA, the Individuals with Disabilities Education Act, mandates that eligible children with disabilities have available to them special education and related services designed to address their unique and individual needs. IDEA has six principles that provide the framework around which special education services are designed and provided to students with disabilities. These principles include:

• Free Appropriate Public Education (FAPE)
• Appropriate Evaluation
• Individualized Education Program (IEP)
• Least Restrictive Environment
• Parent and Student Participation in Decision Making
• Procedural Safeguards

Free Appropriate Public Education: IDEA guarantees that each child with a disability will have available a free appropriate public education, often identified as FAPE. FAPE refers to special education and related services that:

• "Have been provided at public expense, under public supervision and direction, and without charge
• Meet the standards of the State Educational Agency
• Include an appropriate preschool, elementary or secondary school education
• Are provided in conformity with the Individual Education Program (IEP)" (Section 602(8))

"Appropriate" is the critical term in FAPE - the education that a child with disabilities receives needs to address his or her specific and individual educational needs. As such, what is "appropriate" for one student may not be "appropriate" for another. Determining what is "appropriate" for each student involves several processes. First, an individualized evaluation is conducted. The purpose of the evaluation is to identify the student's areas of strength and weakness in as much detail as possible. The next step is for the IEP team to discuss and develop an IEP for the student. The IEP team generates and identifies appropriate goals and objectives for the student to work on throughout the year. Furthermore, placement and the type of special education and related services appropriate for the student are identified. This decision is based on the goals and objectives that have been developed as well as the child's individual needs. In addition to specifying an appropriate placement, the team must identify and provide the supplementary aids and services in order for the child to succeed in the given educational setting.

Appropriate Evaluation: This principle assures that all children with disabilities are appropriately assessed for the purpose of determining eligibility, educational programming, and individual performance monitoring. Moreover, evaluation activities should gather information related to enabling the child to be involved in the general curriculum. Furthermore, testing and evaluation materials must be selected and administered so as not to be racially or culturally discriminatory. The information gained through the evaluation should be used to assist in the determination of what an "appropriate" education would be for the child.

Individual Education Program: The term Individualized Education Program or IEP refers to "a written statement for each child with a disability that is developed, written and as appropriate, revised at least once per year." Each child's IEP contains statements as to the following:

• "The child's present levels of educational performance including how the child's disability affects his or her involvement in the general curriculum
• Measurable annual goals including benchmarks or short-term objectives
• The special education and related services and supplementary aids and services to be provided
• The program modifications or supports that will be provided to the child
• An explanation of the extent to which the child will not participate with nondisabled students in the regular class and in extracurricular and nonacademic activities
• Any individual modifications made in the administration of State and District wide assessments
• The projected date for the beginning of services, and the anticipated frequency, location and duration of those services
• How the child's progress toward the annual goals will be measured and how the parents will be kept regularly informed of that progress, at least as often as they are informed of their nondisabled children's progress"

Least Restrictive Environment: The Least Restrictive Environment (LRE) is determined based upon each child's individual needs. The law's presumption is that the student should be educated in the regular classroom with nondisabled children, with supplementary aids and services provided as necessary to enable the student to succeed in that setting. A student's placement in the general education classroom is the first option the IEP team must consider. If it is determined that a student cannot be educated in the general education classroom, even when supplementary aids and services are provided, an alternative placement must be considered. As such, schools are required to ensure that a continuum of alternative placements are available. These may include, but are not limited to, special classes, special schools or home instruction.

Parent and Student Participation in Decision Making: Schools are required to involve each child's parent(s) in the development of the child's IEP. Parents must be notified, must give consent, and parent's input must be solicited and considered. Students may be members of the IEP team and participate to the extent possible.

Procedural Safeguards: There are three main components of the law's procedural safeguards

• "To protect the rights of children with disabilities and their parents
• To ensure that the children and their parents are provided with the information needed to make decisions about the provision of FAPE
• Procedures and mechanisms are in place to resolve disagreements between parties"

Medical Necessity and Assembly Bill 88:

Following are highlights of California legislation impacting Behavioral Health practitioners.  Note that this represents only a summary of significant legislation during 1999/2000.  For additional information regarding these bills, as well as full details of all California legislation impacting behavioral health practitioners, please consult the Official California Legislative Information Web Site at http://www.leginfo.ca.gov

Effective July 1, 2000, Assembly Bill 88, the California Mental Health Parity Bill, goes into effect in California.  This bill provides for coverage for severe mental illnesses (as defined below) for persons of any age, and for serious emotional disturbances of children.

Under AB 88 Health Plans must provide coverage for diagnosis and treatment under the same conditions applied to all other covered physical conditions.  Terms and conditions applied to mandated benefits must be applied equally to all benefits under the plan contract-that is, with the same co-payments and applicable maximums.  The requirements of AB88 would go into effect as the benefit renews.

Excerpt from http://www.mhn.com/body/PRmanual/Section_16.htm:

1. Every healthcare plan issued, amended or renewed on or after July 1, 2000 shall "provide coverage for the diagnosis and medically necessary treatment of severe mental illnesses of a person of any age" in an amount equal to those benefits offered "to other medical conditions". Health & Safety Code § 1374.72 (a) [applicable to non-insurance plans]; Insurance Code § 10144.5 (a) [applicable to insurance company plans].

2. "Severe mental illnesses" are defined to include: "(1) schizophrenia; (2) schizoaffective disorders; (3) bipolar disorders (manic-depressive illness); (4) major depressive disorders; (5) panic disorder; (6) obsessive-compulsive disorder; (7) pervasive developmental disorder or autism; (8) anorexia nervosa; and (9) bulimia nervosa". Health & Safety Code §1374.72 (d) (1)-(9); Insurance Code §10144.5 (d)(1)-(9).

3. This new major medical state mandate expressly applies to the following: "(1) outpatient services; (2) inpatient hospital services; (3) partial hospital services; (4) prescription drugs, if the...contract includes coverage [already] for prescription drugs". Health & Safety Code § 1374.72 (b)(1)-(4); Insurance Code § 10144.5(b)(1)-(4).

4. In the "historical and statutory notes" of the above two statutes, the California Legislature "finds and declares" that "mental illness is treatable", that most private health plans "provide coverage for mental illness at levels far below coverage for other physical illnesses", that coverage limitations for mental illness "have resulted in inadequate treatment", that this inadequate treatment "causes relapse and untold suffering for individuals...and their families", that the lack of adequate treatment "has contributed significantly to homelessness, involvement with the criminal justice system, and other significant social problems experienced by individuals with mental illness and their families" and that the failure to provide adequate coverage "has resulted in significant increased expenditures for state and local governments". In conclusion, the California Legislature "further finds and declares that other states that have adopted mental illness parity legislation have experienced minimal additional costs if medically necessary services were well managed". Medical conditions and severe mental illnesses must now be covered equally, limited only by medical necessity.