UnitedHealthcare, DOI Reach Settlement on Autism Therapy
On Monday, California Insurance Commissioner Dave Jones (D) announced a settlement agreement with UnitedHealthcare in whichÂ the insurer agreed to immediately cover specialized therapy for people with autism, the Sacramento Business Journal reports.
The agreement follows similar settlements with Blue Shield of California, Cigna and Health Net. Anthem Blue Cross has been providing coverage under direction by the Department of InsuranceÂ since late 2009Â (Robertson, Sacramento Business Journal, 4/17).
The settlements stem from a dispute over the insurers' complianceÂ with the state's Mental Health Parity Law, which mandates coverage of medically necessary behavioral therapies.
The therapy -- called applied behavior analysis or behavioral intervention therapy -- typically consists of intensive sessions with a therapist who uses conditioning techniques to help influence behavior.
Many insurers have denied coverage for the therapy, arguing that it is not a medical service and that health plans are not required to cover it by law (California Healthline, 2/1).
Last year, Gov. Jerry Brown (D) signed a law (SB 946) that requires all plans as of July 1 to cover the therapy for autism and similar conditions.
As part of the settlements, the insurers have agreed to:
- Maintain an adequate provider network;
- Establish a dedicated customer service unit with specially-trained staff; and
- Provide policy information about screening, diagnosis and treatment.
In a statement, Jones said, "We are pleased UnitedHealthcare joins four other insurers in fulfilling its responsibility to provide this necessary and vital treatment to the stateâs thousands of autistic children."
Meanwhile, a lawsuit alleging that state regulators do not have authority to require coverage of the therapy is on hold in Sacramento County Superior Court.
Nicole Kasabian Evans -- a spokesperson for the California Association of Health Plans, which filed the lawsuit -- said, "Health plans continue to maintain ABA is educational in nature and not required until SB 946 takes effect" (Sacramento Business Journal, 4/17).This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.