CDI Action to Secure Insurance Coverage for Autism

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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

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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

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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.

• Mental Health and Autism 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.