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CA Department of Insurance

CDI Action to Secure Insurance Coverage for Autism

CDI is committed to increased access for transformative behavioral therapy for children with autism. The Department's goal is to ensure that insurance companies are in full compliance with California's mental health parity law, which requires that all medically necessary treatment be provided to children with autism, and with other provisions of the insurance code. CDI has taken action to make sure that insurers follow the law including issuing regulations, supporting legislation, enforcement actions, and assisting individual policyholders on a case by case basis.  

Below please find detailed information about our actions and additional resources including general resources for autism, guides for finding insurance coverage, and links to other departments where helpful resources concerning autism can be found. Please note that the CDI is not responsible for the content of websites that are not authored by our department - including those from nonprofit organizations and other California State Departments.


Autism Related Regulations

The CDI issued both emergency and subsequent permanent regulations interpreting the Mental Health Parity Act and SB 946. The regulations aim to eliminate delays and denials of coverage for autism treatment. The emergency regulations were approved by the Office of Administrative Law, and became effective on March 11, 2013. The permanent regulations were approved March 7, 2014 and replaced the emergency regulations. The text of the regulations, as well as a Consumer Alert, can be found below.

Text of Emergency Regulations

Consumer Alert: CDI Emergency Regulations Prohibit Denial and Delay of Autism Treatment

Text of Permanent Regulations


Senate Bill 946: Behavioral Health Treatment

CDI provided strong support for SB 946, which ensures coverage of behavioral health treatment including Applied Behavioral Analysis (ABA) Therapy for autism. In addition, the department continues to monitor new legislation with the potential to impact autism and related disorders. In support of the law, the CDI has initiated enforcement actions against a number of insurers to obtain coverage of ABA therapy. See enforcement actions, below.

Information on Senate Bill 946 and the role the CDI has played in supporting this new law can be found below, along with current relevant legislation and litigation associated with, or having the potential to impact, autism.

CDI Consumer Alert: Know Your Rights to Autism Treatment

Video of Senate Select Committee Hearing
The video can be found under the heading: "Health Insurance Coverage for Autism Spectrum Disorders (ASD) - 07/13/2011"

Transcript of Commissioner Dave Jones' Testimony

Photos and Video of September 26th Rally

CDI Position on the Scope of the Mental Health Parity Act; Statement of Support for SB 946

SB 946: Chaptered Law


Other Relevant Legislation

SB 951: Health care coverage: essential health benefits

AB 1453: Essential health benefits


Litigation

Harlick v. Blue Shield: Amicus Curiae submitted by CDI

Burton v. Blue Shield (This decision is being appealed)

Shahzeb v. Regional Center of the East Bay

Rea v. Blue Shield of California

Elliot v. San Andreas Regional Center

Rea v. Blue Shield: Amicus Curiae submitted by CDI


Governmental/Scientific Support for ABA Therapy

ABA Therapy for Autism is Nationally Accepted and Approved

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Enforcement Actions: Insurers to Provide Coverage for Behavioral Health Treatment

In terms of ensuring coverage of ABA therapy after the passage of SB 946, the CDI has engaged in the following enforcement actions with insurers to require coverage of behavioral therapy for autism. Also included is a Notice the CDI sent to all admitted insurers in the state of California, reminding them that the CDI is committed to enforcing the provisions of the Insurance Code governing Independent Medical Review of disputed health care.

Blue Shield: Order to Show Cause, Order, Settlement

Health Net: Order to Show Cause, Stipulation and Waiver

CIGNA: Order to Show Cause, Stipulation and Waiver

UnitedHealthcare: Order to Show Cause, Stipulation and Waiver

Anthem: Order to Show Cause, Stipulation and Waiver

Related Press Release

Notice to Insurers of Enforcement of Independent Medical Review Statutes


Independent Medical Review

General information concerning the IMR process, including a Consumer Alert: "Challenging Denials of Health Claims and Requesting an Independent Review"

Statistics for current and prior year decisions

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Help Getting Insurance Coverage for Autism

For help obtaining insurance coverage for autism and other disorders, we hope you'll find the following information useful. Additionally, some general resources have been listed as well as a number of related organizations to visit for further information.

FAQs: Obtaining Coverage of Behavioral Health Treatment through Your Insurer

Autism Health Insurance Project

AHIP is a 501 (c3) Public Benefit Corporation that works with families, providers and other relevant parties and helps them secure health insurance and other coverage for autism related interventions. AHIP provides information for both state regulated and self-insured health plans.


General Resources

Autism Speaks: Resource Guide for CA

Special Needs Network: Tools for Transformation; A parent and professionals conference

The Autism Society: Resources for family members of individuals with autism


Other Governmental Agencies

California Department of Developmental Services
The DDS provides services and support to individuals with developmental disabilities.

California Department of Managed Health Care
The DMHC regulates HMOs and other Managed Health Care Plans.

California Department of Mental Health
The DMH works in partnerships to ensure the availability of services for people with mental illnesses through advocacy, education, and outreach.

Senate Select Committee on Autism and Related Disorders
The Senate Autism Committee promotes policies and legislation to assist individuals with Autism Spectrum Disorders.

Substance Abuse and Mental Health Services Association
SAMHSA seeks to connect people to substance abuse and mental health services and to translate research in these areas more effectively and rapidly into the general healthcare system.


Related Organizations

Autism Speaks
Autism Speaks is an autism science and advocacy organization dedicated to funding research into the causes, prevention, treatments and a cure for autism.

Autism Deserves Equal Coverage

Autism Deserves Equal Coverage (ADEC)'s mission is to help parents, providers, agencies, and other organizations that work with families to secure insurance and coverage interventions for children on the autism spectrum and other disorders.

California Autism Foundation
California Autism Foundation (CAF) offers state funded programs for children and adults with autism and other developmental disabilities.

California Coalition for Mental Health
The CCMH is an advocacy alliance that monitors the implementation of the Mental Health Services Act (MHSA), and offers trainings and other information regarding the MHSA.

California Healthcare Foundation
CHCF is a nonprofit grantmaking philanthropy that supports ideas and innovations that improve quality, increase efficiency, and the lower the costs of care.

Disability Rights California
Disability Rights California is a non-profit disability rights organization, working to advance human and legal rights of Californians with disabilities.

Health Access
Health Access is a statewide health care consumer advocacy coalition which undertakes community organizing and education, applied research, and policy analysis, and advocates for reform to benefit health care consumers, both insured and uninsured.

The Autism Society
The primary mission of The Autism Society is to raise and allocate funds to address the many unanswered questions about autism.

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