Autism Deserves Equal Coverage Foundation
News & Legislative Advocacy
Reference: CA regulators justify emergency regulations to SB 946
In late August 2012, California's Department of Managed Health Care proposed emergency regulations to govern the implementation and enforcement of SB 946, the state's autism insurance mandate signed into law in Oct. 2011.  Those regulations were adopted early this year, and the Department's accompanying memo detailing all of the implementation and interpretation issues with SB 946 is important reading, because it shows the myriad ways families are still being denied coverage despite the new law. 

CA Legislature hears from low-income families who lost coverage in Healthy Families to Medi-Cal transition
In late April, members of the Senate Health Committee heard from many low-income families of children with autism who suddenly lost their ABA benefits after their health coverage transitioned from Healthy Families to Medi-Cal as a cost-saving move. In the news coverage below, Kristin stresses the importance of maintaining ABA coverage and asks the Governor to immediately halt the transition so that more families do not lose this essential benefit. 

Insurance Commissioner Dave Jones announces emergency regulations on coverage for autism treatment
Recently, California Insurance Commissioner Dave Jones announced that the California Department of Insurance has issued emergency regulations that will require health insurers to promptly provide medically necessary treatment for autism. Kristin and other advocates have pushed hard for the regulations, reacting to ongoing problems families are having accessing care even when their insurance plan is covered under the SB 946 mandate. For example, policyholders have been asked to submit to intelligence testing to receive continued authorization for behavioral health treatment, even though there is no scientific evidence that cognitive impairment limits the progress a child can make with ABA or other forms of behavioral intervention for autism. California-regulated plans will no longer be able to enforce visit limits for speech or occupational therapy, nor will they be able to enforce dollar limits on such treatment (unless such dollar limits are applied to treatment across the plan's benefits). 
Legal opinion: Regional Centers must pay deductibles for insurance-covered behavioral health treatment
A California family recently won an appeal after the Regional Center refused to cover ABA costs to satisfy their high-deductible insurance plan. The Hearing Officer found that [the Lanterman Act] does not justify RCEB's decision to discontinue funding of ABA servcies for claimant. ABA services are not available from claimant's health insurer because claimant has not met the deductible. . . [The law prohibits the regional center from denying services to claimant that he is qualified to receive, but unable to pay for."
Legal opinion: Regional Centers must pay co-pays for insurance-covered behavioral health treatment

According to a recent legal opinion commissioned by the Association of Regional Center Agencies, it is a violation of the Lanterman Act to require payment of co-pays for services covered by insurance. Financial means or ability to pay cannot be considered, the opinion says. 
Florida judge finds Medicaid must cover Applied Behavior Analysis for autism
A Federal judge in Florida found that the state's Medicaid program must cover ABA and definitively stated that the treatment ismedically-necessary for autism, not experimental. In January 2013, the state said it would appeal the ruling. 

****News Flash! Governor Brown signs SB 946 into law, bringing autism insurance reform to California! 
Part of our work at Autism Deserves Equal Coverage is advocating with policymakers for insurance reform. In 2011, Kristin did significant policy analysis work on SB 946 (Steinberg), an insurance reform bill sponsored by the Alliance of California Autism Organizations (ACAO).  SB 946 was signed into law by Governor Jerry Brown on October 9, 2011. Kristin serves on the Steering Committee of ACAO and represents the organization in testifying on autism insurance issues before the legislature.  She is also a Member of the Statewide Coordinating Council of the Senate Select Committee on Autism and Related Disorders under Senator Darrell Steinberg and Chair of its Bay Area Autism Regional Task-force (BAART) under Senator Elaine Alquist. She also serves as Autism Speaks Statewide Advocacy Chair for Californa. Here are current autism insurance advocacy alerts and resources for families and providers:

Kristin featured in press coverage on settlement agreements negotiated between California insurance regulators and insurance plans:
Information on California autism insurance reform bills :
Video testimony from the California Senate Select Committee on Autism, July 13 2011:
Autism Deserves Equal Coverage Foundation

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