Autism Advocates Say Expanded Coverage Deal Will Not Fulfill Promises

Autism and consumer advocacy groups are criticizing a deal reached last week between the state and Blue Shield of California on coverage for children with autism, saying the agreement will not actually expand therapy services, the San Francisco Chronicle reports.

Advocates from the Alliance of California Autism Organizations, the Special Needs Network and Consumer Watchdog sent Gov. Jerry Brown (D) a letter criticizing the agreement (Buchanan, San Francisco Chronicle, 7/20).

Background

Blue Shield of California recently signed an agreement saying it will pay for a certain type of autism therapy that it previously had refused to cover.

The treatment -- called applied behavior analysis or behavioral intervention therapy -- typically involves 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, 7/14).

California's Department of Managed Health Care announced last week that it had reached a similar deal with Anthem Blue Cross.

Advocates Speak Out

In the letter, the advocacy groups said the deal "contains such onerous requirements for families with autistic children that it will lead to delays, interruptions and continued denials of treatment."

Advocates said the agreement requires autism treatment providers to have a license or be supervised by a licensed individual, but no state license exists for the therapy.

They added that they do not think other licensed health care professionals will begin offering the treatment and that the agreement does not guarantee a network of providers for the therapy.

Senate President Pro Tempore Darrell Steinberg (D-Sacramento) said he will seek further action on the issue in the Legislature.

State, Insurers Respond

Lynne Randolph, a spokesperson for DMHC, said the department "disagrees with the characterizations brought on by some advocacy organizations regarding settlements reached to provide necessary services to families affected by autism."

Tom Epstein, vice president of public affairs for Blue Shield, said the insurer agreed to provide coverage that it does not believe is required by law.

Epstein added, "We are doing it voluntarily and doing it in good faith to get people access to care they believe they need while these issues are litigated" (San Francisco Chronicle, 7/20).