State Regulators Might Require Health Plans To Cover Autism Therapy
California health insurance officials might be changing course on autism coverage in response to a recent court ruling, the Los Angeles Daily Journal reports.
Last week, state regulators sent letters informing five families that California's mental health parity law requires health plans to cover behavioral therapy for autistic children. The families previously filed appeals with the state after insurance companies refused to cover the costly treatment.
Observers say the letters suggest that the state soon might make it more difficult for insurers to deny coverage for some autism treatments.
California's mental health parity law requires insurers to cover mental conditions to the same degree that they cover physical ailments.
However, many insurers avoid covering an autism therapy called applied behavior analysis because they claim it is an educational treatment rather than a medical service. ABA can cost up to $70,000 annually per child.
The Department of Managed Health CareÂ initially forwarded any coverage disputes over ABA to independent medical review panels. However, in March the department issued a memo indicating that it would channel coverage appeals to DMHC's attorneys rather than to the independent panels.
In response to the change in procedure, the advocacy group Consumer Watchdog filed a complaint against the state.
Los Angeles Superior Court Judge James Chalfant recently issued a preliminary ruling suggesting that California's new autism coverage policies might be inconsistent with other state laws regarding health plans.
Chalfant's decision sets the stage for the case to proceed to a full trial in April (George, Los Angeles Daily Journal, 11/13).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.