Health Care Reform: Recent News & Events

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California Files Emergency Autism Benefits Regulations - Friday, March 1, 2013

Source: LifeHealthPro. Click here.

By Allison Bell

The California Department of Insurance is trying to improve compliance with the autism treatment benefits law created by S.B. 946 by adding an emergency regulation, officials said today.

The proposed emergency regulation declares that the California Mental Health Parity Act of 1999 and the S.B. 946 law require health insurers in the state to cover all forms of medically necessary autism treatment, including intensive behavioral therapy.

Intensive behavioral therapy can cost $30,000 per year or more.

California Gov. Jerry Brown, D, signed S.B. 946, an autism treatment benefits mandate bill, in October 2011.

California Insurance Commissioner Dave Jones put out a statement arguing that enforcing compliance with the law could improve California public finances.

When lawmakers were debating S.B. 946, "the legislature found that autism was one of several severe mental conditions that were seriously disabling, and that failure to provide adequate coverage in private health insurance policies significantly increased expenditures for state and local governments," according to officials in Jones' office.

Since S.B. 946 took effect, the California department has received 71 complaints, and it has received reports that about 1,600 individuals who are moving from regional, government-supported centers to insurers for autism treatment have experienced delays and denials, officials said.

"Children with autism and their families deserve the medically necessary treatment that will ensure they can succeed in school, in their communities, and reach their potential for a greater and improved quality of life," Jones said.

Brad Wenger, president of the Association of California Life and Health Insurance Companies (ACLHIC), said his group is happy to see the department developing a regulation implementing the S.B. 946 law.

The ACLHIC had asked the department to adopt regulations that would clarify the law's requirements, Wenger said.

If Jones succeeds at implementing the regulation through an emergency regulation process, that will dramatically reduce interested parties' ability to comment on the regulation before it takes effect, Wenger said.

"Our companies would have preferred to share their views in the context of a normal public comment period," Wenger said.

The proposed regulation appears to provide autism with a greater level of coverage than other types of mental illnesses, and that greater level of coverage appears to conflict with the statutory parity standards, Wenger said.

Insurers believe that ideas about how to handle severe mental illnesses are still evolving and would like to see the regulations allow flexibility to accommodate advances in medical science, Wenger added.

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