Suit Challenges Calif. Regulators on Oversight of Autism Coverage
On Tuesday, Consumer Watchdog filed a lawsuit against California's Department of Managed Health Care alleging that state regulators are violating a state law by permitting insurers to deny coverage for some autism treatments, the San Francisco Chronicle reports (Colliver, San Francisco Chronicle, 7/1).
In 1999, California passed the Mental Health Parity Act, which requires insurers to cover services for mental and behavioral 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.
DMHC initially forwarded any coverage disputes over ABA to independent medical review panels, which typically ruled in favor of the families seeking treatment.
However, in March the department issued a memo indicating that it would channel consumer complaints to DMHC's coverage dispute division instead of independent medical review panels.
The suit maintains that the change in policy has resulted in insurers typically winning the coverage disputes, leaving members to cover the cost of the autism treatments (Girion, Los Angeles Times, 7/1).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.