An Act to Provide Equal Access to Evaluations for Children with Disabilities
Testimony for the Joint Committee for Children, Families, and Persons with Disabilities
July 14, 2015
My name is Dr. Stephanie Monaghan-Blout. As the president of the Massachusetts
Neuropsychological Society and a practicing pediatric neuropsychologist, I appreciate the
opportunity to speak in favor of the Independent Educational Evaluation bill offered by
Representative Sannicandro and Senator L’Italien.
The goal of the independent educational evaluation is to provide an expert, unbiased assessment
of a child’s needs, accompanied by recommendations for needed instruction and services by a
specially trained pediatric neuropsychologist. Current law states that parents have the right to
obtain an independent educational evaluation, but the reimbursement rates are so low that that they
do not cover overhead costs, so most neuropsychologists cannot afford to take these referrals. My
colleagues and I are very concerned about the inequities of access and quality in independent
educational evaluations.
Access
Place yourselves in the position of a parent whose child cries every morning because she has to go
to school. She protests that school is too hard- she feels stupid and nobody wants to play with her.
She has an Individualized Education Program (IEP) but it doesn’t seem to be working. You hear
that you can request an Independent Educational Evaluation and you start asking people for names
of evaluators. Your pediatrician gives you two names, your neighbor gives you a name, and one
of the parents on your child’s soccer team gives you a fourth name. You call all four people only
to learn that none of them accept the state rate. What do you do?
How about insurance? The current position of most insurance companies is that they do not cover
“educational” evaluations, that is, those in which the question may involve learning issues. When
a case can be made for “medical necessity”, insurance will only cover the non-educational aspect
of the evaluation, and even then the rate of reimbursement varies dramatically depending on the
insurance company.
What about publicly funded resources for low-income children such as Medicaid and Mass Health?
Most of the providers who take these programs are located in hospitals, where the wait list can be
up to a year. Furthermore, there are limitations placed on those providers, which severely restrict
the utility of those evaluations. For instance if a neuropsychologist accepts Mass Health for an
evaluation, they may not take any reimbursement from parents for any related services such as a
team meeting or observation. This puts parents and providers in an impossible situation. One of
our members reported that she has had parents who have tried barter such as gas cards in order to
pay for her appearance at a team meeting but she was required to refuse.
Quality
The second serious concern about the current situation is the quality of evaluations that can be
conducted within the constraints of the current situation, because only “direct service” or testing
is covered. This eliminates critical portions of the evaluative process.
Children are not yet capable of telling us about their learning, social, and emotional issues. For
this reason, a good developmental history is an essential part of the evaluation. For example, a first
grader may be having trouble learning to read and following class rules, such as staying in her seat.
Knowing whether the child comes from a family with a history of learning disabilities or has just
landed in their fourth foster home is critical to formulating a plan for the assessment.
The need for collateral information- the perspective of teachers and other caregivers- is also critical
to understand the nature of a child’s difficulties. For instance, does the child always have trouble
sitting in their seat or is it only during reading lessons? Often it is necessary for the
neuropsychologist to observe the child and the program. When evaluators, parents and special
education teams can sit together and talk, they can often come to a better understanding of how to
provide for a child’s needs, which may avert further contention and cost.
However, the current law governing independent evaluations does not provide for any of these
non-testing components that are so important in helping the child and his teachers. As a result, the
evaluations conducted run the risk of coming to incorrect conclusions because they lacked access
to important information, and the utility of the evaluation is undermined when the evaluator cannot
be available to explain their findings. This isn’t fair or even cost effective.
On behalf of the membership of the Massachusetts Neuropsychological Society, we urge you to
move favorably on this bill to support the children of Massachusetts.
________________________________
Stephanie Monaghan-Blout, Psy.D
President, Massachusetts Neuropsychological Society
[email protected]
617-658-9816
___________________________________________________________
www.massneuropsychology.org
P.O. Box 523 Sudbury, MA 01776
(617) 742-6719