It is this professional’s opinion that the Massachusetts Division of Insurance, the health insurance lobby, the Massachusetts Department of Education, and the political influence of public sector unions, collude to exclude educationally related neuropsychological and psycho-educational testing from health insurance coverage. Dubious, capricious, and arbitrary explanations of “medical necessity” are provided by insurance companies such as “neuropsychological testing (NPT) is considered as medically necessary when provided to aid in the assessment of cognitive impairment due to medical or psychiatric conditions” and “NPT or PT for educational reasons is not covered – this testing is usually provided by school systems under applicable state and federal rules – NPT or PT performed for educational reasons is not considered treatment of disease.” Such logic is twisted into a pretzel for sure but it is also profligate logic.
I would caution you against accepting the district’s non-eligibility decision carte blanche. Having a special education advocate or educational psychologist review the school district’s initial evaluation for special education eligibility is a prudent step for parents to take. In most circumstances it is also prudent to get an independent evaluator’s opinion from outside the school district. In any event, the critical question that needs to be addressed by educators is whether or not your child is making effective progress academically given his general intellectual potential – Is he/she realizing academically the full expression of his/her intellect?
If your child has discrepancies between ability and achievement (in combination with below average performance relative to children of comparable age), in any academic area including word reading, reading comprehension, pseudoword decoding, numerical operations, math reasoning, listening comprehension, spelling, or written expression – he/she should be found eligible for an Individualized Education Program. If your child shows no underachievement academically but ADHD is interfering with his ability to benefit from his/her public school education than he/she should receive a 504 plan with Other Health Impaired as the eligibility category.
Children with untreated ADHD are at high risk for academic underachievement and usually eventually qualify for an IEP due to gaps in learning over time. The WISC-V or Reynolds Intellectual Assessment Scales could be added to the ADHD evaluation to address a question about his/her overall intellectual capacity. Special education advocates and special education attorneys usually look to a Neuropsychological Testing Evaluation to help enforce the Individuals with Disabilities Education Act (IDEA) and the All Handicaped Children Act. The cost is high in part because the document is a legal document that in some cases is sent to the Board of Special Education Appeals (BSEA) hearing in Boston.
Many parents don’t realize that the range of cost for special education for children with SLD or multiple disabilities is from a few hundred dollars a week for a single pull out service such as OT all the way up to $160,000 per year in a residential education program. There are hundreds of potential services at various level of intensiveness and cost that fall in between that the school district is responsible for providing for handicapped students as well ancillary services such as transportation. They can only be obtained with an IEP and getting an IEP often requires a comprehensive independent Neuropspychological Testing Evaluation and vigorous advocacy.
1. Deliver a letter to the Director of Special Education of your child’s school district requesting a comprehensive initial evaluation for special education eligibility. The evaluation should consist of a cognitive evaluation including intellectual and academic achievement testing as well as a psychological assessment (i.e., evaluation of social, emotional, and behavioral functioning).
Moreover, if gross motor, sensory motor or speech and language problems are suspected, consider requesting a Physical Therapy (PT), Occupational Therapy (OT), and/or Speech/Language evaluations. Be sure to sign and date the letter as well as getting it time stamped when possible.
2. Monitor the 30 day deadline (30 days for Massachusetts students – check your state’s regulations regarding the applicable time frame) for completion of the initial evaluation from the date of the time stamp on the letter.
3. Monitor the 45 day deadline (45 days for Massachusetts students – check your state’s regulations regarding the applicable time frame) for scheduling a special education team meeting from the date of the time stamp on the letter. The purpose of the team meeting is to discuss the findings of the initial evaluation.
4. Consulting with a special education advocate is recommended at this point and her/his attendance at the team meeting is recommended.
5. Attend the special education team meeting, along with the advocate (if acquired), to review the findings of the school district’s initial evaluation of your child.
6. At the team meeting make no decision and do not sign any forms accepting a team decision regarding eligibility for special education or special education service proposals.
7. Following the team meeting, discuss with your advocate the process of the special education team meeting, the disposition, and any service proposals.
8. If eligibility is denied or if eligibility is approved but you are not satisfied with the service proposal, consider filing a written request for an Independent Educational
Evaluation (IEE) with the Director of Special Education. This letter should contain a
statement that you are not satisfied with the district’s initial evaluation. Any component of the school district initial evaluation, the evaluation in its entirety, or a comprehensive neuropsychological evaluation may be specified in the IEE letter for the independent evaluator to perform.
9. Monitor the time frame for a response from the Director of Special Education to your request for an IEE. Check your state’s regulations regarding the applicable time frame.
10. After receiving approval for the IEE, research potential state licensed clinical psychologist providers or other qualified and state licensed providers depending on the
specialty of service needed, for the IEE. Keep in mind that many licensed providers do not accept the state rate (State Rate Setting Commission’s rate of reimbursement) as payment in full and will balance bill their clients up to their usual and customary charges for service.
11. Have your child complete the IEE and request a meeting with your child’s school team to discuss the findings of the IEE. Again, it is recommended that the special education advocate attend this meeting.
12. Carefully review with your advocate the process of the IEE meeting, as well as team recommendations regarding eligibility for special education, and proposals for service.
13. If you continue to have concerns about your child’s having unmet special education needs, discuss your options with the special education advocate up to an including an appeal, i.e., a request for a hearing with the state Board of Special Education Appeals.