April 4, 2019

On March 21, the Policy and Analytics Center (PAC) at the A.J. Drexel Autism Institute, Drexel University Thomas Kline School of Law, Philadelphia Autism Project, Pennsylvania Health Law Project, and the Autism Services, Education, Resources and Training Collaborative (ASERT) Eastern Region hosted a public discussion of the landmark Pennsylvania Supreme Court case, Burke v. Independence Blue Cross (IBC). This case solidified insurance coverage for Applied Behavior Analysis (ABA) services for students in Pennsylvania schools. Panel members for this discussion included David Gates Esq., the lead attorney; Dennis M. O’Brien, former Speaker of the Pennsylvania House of Representatives; Nina Wall, Director of the Pennsylvania Bureau of Autism Services and John Burke, the plaintiff and father of a student who had been denied services.

The panel discussed key components of the case that ultimately upheld the court’s decision for insurers to cover diagnosis and treatment of autism spectrum disorder (ASD) for children and youth under 21 years old.  Otherwise known as the Pennsylvania Autism Insurance Act, “Act 62” requires many private health insurance companies to cover these services. The long-fought battle to mandate the coverage of ABA therapies within school began in 2008. John Burke, plaintiff in Burke v. IBC, and his wife Sue were denied ABA service coverage for their son Anthony (Tony). For nearly 8 years the Burke family fought tirelessly to ensure that Tony would receive the ASD support services he needed in school. "Tony was progressing developmentally with the assistance of an ABA therapist. We often wondered how far his development would have gone had IBC not taken that away from him,” John Burke said of the services his son was denied.

David Gates, Esq., Director of Policy and a Senior Attorney for the Pennsylvania Health Law Project, was the lead attorney representing the Burke family against Independence Blue Cross. Gates has been representing families and adults regarding issues involving Medical Assistance and other forms of health insurance since 1976.

The perseverance of the Burke family and David Gates led to a decision that will benefit many families across the commonwealth, and allow their children with ASD to receive the services they need. It is important for the ASD community to be aware of available resources. Additional information about the Autism Insurance Act can be found on the ASERT Collaborative Act 62 page the Department of Human Services Act 62 page, and at the PA Health Law Project.  

The mission of the Policy and Analytics Center (PAC) is to utilize research methods and innovative analytic strategies to support the development of effective social and health policy in cities, states, and across the US. More information about this event can be found at www.phillyautismproject.org/Burke.

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