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California Mandated Autism Coverage
The new California Autism Insurance Mandate requires all health plans and policies to provide coverage for behavioral health treatment for autism, pervasive developmental disorder and applied behavioral analysis, known as ABA. This also includes speech and occupational therapies.
Senate Bill 946 takes effect on July 1, 2012. This is for all individual and family plans through small and large groups. The insurance coverage is for assessment and treatment plans.
Those families that have children on the autism spectrum that are consumers of the Regional Center system are familiar with the process of obtaining an assessment first for a related therapy and the time that is involved in funding the assessment, receiving the report and then having to go through the process of obtaining said therapy for a set period of time. This could last for several months while factoring in waiting lists at the agency just to make an appointment for the assessment.
In my experience agencies usually visit more than one time during the allotted time period for the assessment. The report needs to be completed and sent for approval. Some agencies will send a report to the family at the same time they send it to the Regional Center.
Recently I requested insurance to cover the adult underwear I started using for my sixteen year old nonverbal son. It has taken almost a month to get the delivery to my house and it turned out to be the wrong product. Parents need to be diligent in following through with Doctors, Insurance providers and pharmacies to know when prescriptions expire and the approval process. A log of the phone calls is necessary with relevant information for future use.
This new insurance mandate does not affect families that are on Medi-Cal. This is only for those that get their insurance through an employer. This will also affect the therapies they are receiving through the Regional Center if they have an insurance plan.
I also attended a webinar on these changes by Trumpet Behavioral Health. Here is more information on their workshops.
This is a listing of all health insurance companies offering group plans in the State of California.
The Autism Society of America has a search option to find all the service providers of ABA in the State of California.
Vista Center for Behavior Analysis
Anthem and Blue Shield to cover therapy for autistic children
Blue Shield Settlement
Insurance Coverage for Autism, National Conference of State Legislatures - January 2012
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