---
date: "2025-10-22"
speaker: "Conference recap by Jim Hamilton"
organization: "Autism Law Summit"
topic: "Autism Law Summit 2025: Standards of Care, Parity & Special Education"
blurb: "Notes from the 2025 Autism Law Summit in Orlando. Highlights include a state-by-state look at writing generally accepted standards of care into law, the newest parity arguments against caps and utilization review, a special education panel on IEPs and compensatory services, and a hard conversation about safety and first responders."
---

# Autism Law Summit 2025: Standards of Care, Parity & Special Education

**Date:** October 22–23, 2025
**Location:** Orlando, FL
**Recap by:** Jim Hamilton

> The [Autism Law Summit](https://autismlawsummit.com/) brings providers, attorneys, regulators, and a few parents together each fall to work on the practical law of getting autism services covered. Lorri Unumb opened the 2025 summit with two pieces of good news: TriCare is now paying for ABA services, and the 2014 Medicaid settings rule continues to push states away from funding services that isolate people with disabilities from the general community. Here is what stood out for our families.

## Getting standards of care into state law

One of the best sessions was a start-to-finish account of how a Virginia provider organization got a bill clarifying "generally accepted standards of care" through a single legislative session, from a December crisis to a governor's signature in March. The lessons travel:

- Almost all of the work happens out of public view. By the time there is a public hearing, the outcome has usually been shaped in meetings, phone calls, and redlines.
- Learn the actual path a bill takes in your state: which subcommittee, which committee, which deadlines. Missing a filing deadline costs you a year.
- Build a coalition wider than autism. The bill moved because it protected everyone with a mental health diagnosis, not one diagnosis group.
- Borrow language that has already passed somewhere else, and be willing to trade wording that is not load bearing to keep the substance.
- Real family stories, told locally, are what get a legislator's attention in the first place.
- Afterward, thank the people who voted for you in writing. It costs nothing and it matters for the next bill.

## The parity arguments that are working now

From the legal update and the insurance sessions:

- A payer's purchased or internally written review criteria are not the "generally accepted standards of care" and cannot override them. For ABA, the [CASP practice guidelines](https://www.casproviders.org/asd-guidelines), now in their third edition, are the standard, and the third edition speaks directly to treatment in school settings.
- Those standards keep gaining official recognition. The legal update walked through a [National Academies](https://www.nationalacademies.org/) review of TriCare's autism care program that recommended covering ABA as a permanent, basic benefit and eliminating assessments that do not support treatment planning, and an American Medical Association policy that definitions of medical necessity must put quality and clinical effectiveness above cost. The full slides are in the deck attached below.
- A plan cannot delegate its way out of parity. If a plan buys someone else's utilization management criteria and those criteria are more restrictive for mental health than for medical or surgical care, the plan still owns the violation.
- Denials tied to whether a parent completed enough parent training are worth challenging. Ask whether the plan imposes a comparable participation requirement on the medical and surgical side, and ask exactly what it thinks is required.
- Automatically routing every autism authorization to peer review, when nothing comparable happens on the medical side, is itself a parity problem.
- Hour caps and age caps do not survive parity analysis on commercial plans, and parity applies to Medicaid managed care too. Watch for the Medicaid "soft cap," a stated hour limit that is supposedly flexible: if the plan never actually justifies the cap in your child's individual case, it is functioning as a hard cap.
- You can request the plan's written comparative analysis of its non-quantitative treatment limitations. Most families get nothing back, and that silence is useful with your regulator. Ask both generally and specifically about the limitation applied to your child.
- The September 2024 federal parity rule is being challenged in court by an employer group, and parts of it are on hold. The message from the legal update was do not panic: everything in the 2013 parity rule remains in effect, the requirement to produce a comparative analysis still stands, and excluding a core treatment like ABA was already unlawful before the new rule existed.
- Always pair the legal argument with a policy and cost argument: describe what happens if the treatment is not covered, and what the later crisis costs the state.

## Special education: the panel that made me take the most notes

- [COPAA](https://www.copaa.org/), the Council of Parent Attorneys and Advocates, is worth joining as a parent. It maintains a directory of special education attorneys and advocates.
- Write your disagreements down. Anything you object to belongs in the "parental concerns" section or under your signature on the IEP itself; that is what gets the ball rolling later. And insist on process when placement changes: a [federal court in Philadelphia held](/sessions/20251022_Autism_Law_Summit/IDEA%20Change%20of%20Placement%20Decision%20%28Autism%20Shuffle%29.pdf) that moving a child with autism to a different school building is a change in educational placement, because "difficulty with transition is one of the defining characteristics of children with autism," so the district owes you a written explanation of why the transfer is proposed, what other options were considered, and why they were rejected. The same opinion is honest about the ceiling: parents get notice and input, not veto power over the site.
- Ask basic questions in the meeting until the answer is clear. When someone reports a score, ask what the assessment is, what the scale is, and what the number means for your child.
- The parents hold the right to an Independent Educational Evaluation; the district does not have an equivalent right.
- Least restrictive environment is not about a room. It is about the setting where your child is actually making progress. For what unnecessary segregation looks like when the federal government investigates it, the [DOJ letter of findings on Georgia's statewide GNETS program](/sessions/20251022_Autism_Law_Summit/DOJ%20Letter%20of%20Findings%20-%20Georgia%20GNETS%20Segregation.pdf) is a readable example: exit criteria demanding a student "maintain physical self control 100 percent of the time" held disabled students to a higher standard than their general-education peers, and DOJ's position was that individualized behavior supports "can and should be provided ... in general education schools" (p. 11).
- Relief in a special education case is generally compensatory education rather than money, and how it is calculated depends on your jurisdiction. One attorney on the panel described a multi-year case that ended with a hearing officer awarding thousands of hours of services, delivered by a provider of the family's choosing. Two financial footnotes: prevailing parents can recover attorneys' fees, and courts have refused to discount those awards just because a district says it is broke ([a Philadelphia fees decision](https://www.autismlegalresourcecenter.com/media/4nlpg4nk/m-m-_fees_decision.pdf) makes both points), but a timely settlement offer from the district can cut off the right to fees if you win less at hearing than the offer, so read any offer carefully with counsel.
- For a sense of how school ABA cases actually come out, the [2015 sampling of ABA school cases](/sessions/20251022_Autism_Law_Summit/Summary%20of%20ABA%20School%20Cases%20%282015%29.pdf) from the Autism Legal Resource Center lists decisions circuit by circuit, and it runs in both directions: districts have won by offering non-ABA programs a court found appropriate, and districts have lost by predetermining the program or delaying a parent's ABA request for a year. It also preserves the education system's standard counterargument, a federal OSEP letter reminding agencies that ABA "is just one methodology," which is exactly what a district will say back when you cite medical practice guidelines in an IEP meeting. It is a dated, non-comprehensive list, but it will calibrate your expectations before due process.
- Several attorneys are pursuing school access for medically necessary ABA under the ADA rather than under special education law, on the theory that a request you could make of a library or a museum is not really a dispute about the adequacy of an education. Go in with clear eyes, though: in the Philadelphia placement case above, the IDEA claim won while the ADA and Section 504 claims lost outright, and DOJ's own Georgia letter says the ADA's integration requirements are generally met through proper implementation of the special education laws. The access theory is a genuine tool, not a shortcut around a hard IEP fight.
- Four ways to push for change, roughly in order of escalation: raise it at the IEP meeting, file a complaint with your state department of education (anyone can file, and it gets the higher-ups involved), request due process, and, where the issue is access rather than education, an ADA claim.
- A resource the panel recommended: the [Master IEP Coach](https://masteriepcoach.com/) program for parents who want to build their own advocacy skills.

## Coding and billing questions that affect families

- ABA and speech therapy should be allowed on the same day. They cannot be billed for the same minutes, but a same-day denial is worth questioning when the medical necessity is documented.
- The ABA code set is being revised, with new codes effective January 1, 2027. Expect payer policies to lag and plan to push back on denials that cite outdated policy documents.
- If a payer's written policy contradicts the coding guidance, point the payer to the [ABA Coding Coalition](https://abacodes.org/), which publishes the guidance the codes are based on.

## Networks, denials, and pressure on hours

- If your plan's provider directory does not produce a provider who can actually see your child, document every call. Some states require the plan to cover out-of-network care at in-network cost when it cannot deliver an in-network option, and a grievance is how you start that clock.
- Regulators are starting to look hard at this. A [federal inspector general audit](https://oig.hhs.gov/reports-and-publications/all-reports-and-publications/cms-did-not-ensure-that-selected-states-complied-with-medicaid-managed-care-mental-health-and-substance-use-disorder-parity-requirements/) found that state Medicaid managed care programs were not enforcing parity requirements, and investigative reporting in late 2024 documented a major national carrier strategically limiting its ABA network while families sat on waitlists. If that matches your experience, your documentation is part of the pattern regulators need to see.
- A concerning pattern discussed at the summit: providers who request fewer hours stay in the plan's good graces. If your child's prescribed hours dropped without a clinical reason, ask your provider directly whether the request reflects the assessment.
- If your appeal gets no real response, escalate in order: file a grievance with the plan, complain to your state insurance department, and go to the state regulator with the paper trail. Denials are supposed to grapple with your child's actual record, not recite boilerplate.
- Under Medicaid, if you are denied medically necessary treatment or left waiting without reasonable promptness, you can request a fair hearing. Bring what you would have put in a prior authorization request: the diagnosis, the assessment, and the medical necessity documentation.
- Free help exists in every state. Each state has a disability rights protection and advocacy organization, plus legal aid for families who qualify by income, and many law schools run clinics. Expect to educate them about autism and ABA, since their caseloads cover every disability.

## Safety, first responders, and self-advocacy

A panel question about people on the spectrum being harmed during encounters with law enforcement produced the most sobering discussion of the conference:

- Build safety into treatment goals deliberately: how to interact with a police officer, how to recognize and report abuse, and how not to be drawn into it.
- Take advantage of community "day of acceptance" events where kids can visit a fire station or a police station on a calm day and meet the people in the uniforms.
- Ask whether your local provider associations offer training to police and first responders, and whether your state has a voluntary registry, along with any policy requiring dispatchers to check it.
- The most useful frame I heard, from a self-advocate's argument: you do not really have a choice if you do not have the skill. Teach the skill first, then respect the choice.

## Free resources highlighted at the summit

- [Autism Legal Resource Center slide library](https://www.autismlegalresourcecenter.com/resources/library/listing?page=1&cat=1321): the summit's presentation decks, including past years, posted publicly.
- [ABA Coding Coalition](https://abacodes.org/): coding guidance, the Model Coverage Policy, and a question portal that takes questions from parents as well as providers.
- [COPAA](https://www.copaa.org/): parent attorneys and advocates, plus a directory.

---

*These are one parent's notes from a professional conference, shared parent to parent and not legal advice; sessions are cited rather than individual speakers where remarks were informal. Reach out to Jim through the [contact form](/about/) for more information about the Autism Law Summit or help finding any of these resources.*

## Attachments

- `Autism Law Summit 2025 - Legal Update - Slide Photos (searchable).pdf` *(photos of the projected slides from the Legal Update session, made text-searchable; 36 slides)*
- `Autism Law Summit 2025 - Legal Update - Recreated Slide Deck.pptx` *(the slide text recreated from those photos, one slide per photo)*
- `DOJ Letter of Findings - Georgia GNETS Segregation.pdf` *(the Department of Justice finding that a statewide segregated program for students with behavior-related disabilities violated the ADA)*
- `Summary of ABA School Cases (2015).pdf` *(the Autism Legal Resource Center's circuit-by-circuit sampling of school ABA cases; dated and non-comprehensive, with outcomes in both directions)*
- `IDEA Change of Placement Decision (Autism Shuffle).pdf` *(the federal decision holding that moving a child with autism to a new building is a change in educational placement requiring notice and parent participation)*