California Regulators Provide Guidance on Autism Coverage
In a letter sent Monday, the California Department of Managed Health Care informed health insurers that they must cover speech, occupational and physical therapy for autistic members, but the department's letter did not specifically address behavioral therapy, the Los Angeles Times reports.
The letter came in response to recent disputes over insurers' denial of coverage for some services for autistic members.
Behavioral Therapy a Sticking Point
Most recently, insurers argued that behavioral therapy is an educational treatment rather than a medical service.
In 15 cases, a panel of physicians the state retains concluded that behavioral therapy was medically necessary and required insurers to cover the services. A 16th case is pending.
Behavioral therapy can cost as much as $70,000 annually per patient.
Because DMHC's letter did not specifically address behavioral therapy, parents of autistic children are concerned that they will have to appeal insurers' coverage decisions for the service on a case-by-case basis.DMHC said it would create regulations to formalize insurer coverage requirements and "provide additional clarity through an open and public process" (Girion, Los Angeles Times, 3/10). 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.