Insurance Commissioner Dave Jones Reminds Californians of New Autism Treatment Law Effective July 1
News: 2012 Press Release
Insurance Commissioner Dave Jones reminds Californians that a bill reconfirming that insurance companies and health care service plans must provide coverage for behavioral health treatment for children with Autism became law July 1. SB 946 was jointly authored by Senate pro Tempore Darrell Steinberg (D-Sacramento) and Senate Judiciary Committee Chair Noreen Evans (D-Santa Rosa). Commissioner Jones was a strong supporter of the legislation because behavioral health treatment for autistic children can make a big difference in their health and well-being.
The California Department of Insurance paved the way for this legislation by concluding that behavioral intervention therapies, such as Applied Behavioral Analysis (ABA) are mandated under California's previously enacted Mental Health Parity Act ("Act"). Since autism is one of the "parity diagnoses" covered by the Act, the Department of Insurance determined that the Act mandates that all medically necessary treatment, including behavioral treatment, be covered by all policies which provide for hospital, medical, or surgical benefits. The Department of Insurance overturned health insurer denials of claims for behavioral treatment and initiated enforcement actions which resulted in agreements by the major health insurers in California to provide behavioral treatment for autistic children.
The Legislature passed and the Governor signed SB 946 to further clarify that health insurers and HMOs should provide behavioral treatment for autism. "Behavioral therapy is a medical treatment that can make a big difference in the health and well-being of autistic children. Senators Steinberg and Evans are to be congratulated for their legislation which confirms that California law requires health insurers and HMOs to provide behavioral treatment," said Commissioner Dave Jones. "The Department of Insurance will continue to make sure that insurance companies are in full compliance with the laws requiring that all medically necessary treatment be provided to autistic children and that there be no arbitrary limits on occupational and speech therapy. We will also monitor the adequacy of the provider networks which insurance companies develop to provide this treatment."
The Department of Insurance reminds consumers to carefully review their policies and that even if they exclude treatment and/or limit the number of doctor visits, the law entitles them to coverage for behavioral health treatment and visits cannot be limited for treatment if there are not similar limits on treatment for other medical conditions."
"This measure brings a ray of hope for individuals and families who struggle with autism, expanding health care coverage for the behavioral therapy they need," said Senator Steinberg. "Commissioner Jones provided valuable assistance to make SB 946 a reality, and I look forward to our ongoing collaborations to provide critical medical services for children with autism and other disabilities."
For more information about resources and help in getting autism insurance coverage, go to the California Department of Insurance Web site at www.insurance.ca.gov.
The California Department of Insurance, established in 1868, is the largest consumer protection agency in California, regulating the $123 billion insurance marketplace. In 2013 the California Department of Insurance received more than 170,000 calls from consumers and helped recover over $63 million in claims and premiums. Please visit the Department of Insurance web site at www.insurance.ca.gov. Non-media inquiries should be directed to the Consumer Hotline at 800.927.HELP or 213.897.8921. Telecommunications Devices for the Deaf (TDD), please dial 800.482.4833.