Autism Insurance Reform
CALIFORNIA CONTINUES TO ATTEMPT TO ENACT MEANINGFUL AUTISM INSURANCE REFORM LAWS. Twenty-seven states in the U.S. have enacted laws that require private insurance companies to cover evidence-based autism therapies, such as Applied Behavior Analysis (ABA). In California, Senate Bill 166 and Assembly Bill 171 are in the works and would require health insurance companies to provide coverage for behavioral health treatment. Most insurance companies require services to be provided by a licensed provider, so many of these laws have been passed along with laws that mandate the licensure of Behavior Analysts. Behavior Analysts have a rigorous national board certification (BCBA) but have not, until recently, had the option for licensure in most states. In California, the Behavior Analyst Licensure Bill (AB1205) was not passed by the California Assembly Appropriations Committee. Meanwhile, legal precedent is being set in California. On July 13, the California Department of Insurance announced action against Blue Shield for failing to comply with the California Mental Health Parity Act of 1999 by refusing to fund ABA treatments for autism. At a recent hearing of the Senate Select Committee on Autism, representatives of the California Department of Insurance stated that ABA is a common, proven approach that is “not experimental” and has been shown to be “medically necessary” by independent medical reviews. At the same hearing, an announcement was made about a settlement between the Department of Managed Health Care (DMHC) and Anthem Blue Cross to cover ABA treatments for those with autism in California. Similar agreements are pending between Blue Shield and Kaiser. Unfortunately, these agreements require licensed providers, and there is currently no licensure for Behavior Analysts in California. Therefore, even if ABA treatments for autism are covered by private insurance companies in California under the Mental Health Parity Act, they will require supervision by licensed providers who are likely not Behavior Analysts (and may not be qualified to supervise behavioral treatment). Groups such as CalABA, APBA and Autism Speaks continue to fight for autism insurance reform and Behavior Analyst licensure. In states where insurance reform has occurred and ABA treatments are covered, premiums have only risen between .27 and .63 percent, while the reduction in long-term costs to those governments is significant.
