Preliminary Ruling Goes Against Kaiser, DMHC on Autism Coverage
An Oct. 20 preliminary ruling could make it more difficult for insurers to deny coverage of some autism treatments and push California regulators to shift the approach they have taken in reviewing such denials, the Los Angeles Times reports.
The advocacy group Consumer Watchdog brought the suit as part of an effort to require the Department of Managed Health Care to adopt review policies that are more beneficial to consumers.
In an Oct. 20 preliminary ruling, Los Angeles Superior Court Judge James Chalfant found that Kaiser Permanente's denial of a claim for applied behavioral analysis for a member with autism violated California's Mental Health Parity Act.
Kaiser attributed its denial to the fact that the service was not provided by someone who is licensed by the state.Â
However, the Times reports that most autism therapists are certified through a national program but are not licensed by states.
The ruling indicated that requiring providers of autism services to be licensed by the state would in effect permit insurers to deny coverage for all autism services and push people with autism to seek treatment at state centers.
In addition, the ruling agreed with Consumer Watchdog's assertion that a March 9 memo from DMHC to insurers was inappropriate.Â The memo spelled out when insurers must cover autism services.
Next StepsThe preliminary ruling sets the stage for the case to proceed to a full trial (Girion, Los Angeles Times, 10/27). 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.