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Summary of 2011 California Autism Insurance Reform Bill:

September 09, 2011

Senate Bill 946

Not all insurers and health plans in California are subject to the bill. For those that are:

  • Coverage must be available for treatment to "develop or restore, to the maximum extent practicable, the functioning of an individual with pervasive developmental disorder or autism"
  • Treatment must be recommended by a licensed doctor or psychologist and provided under a treatment plan, which must be reviewed by the provider at least every six months
  • Reimbursement must be made for the services of Board Certified Behavior Analysts, as well as the professionals and paraprofessionals whom they supervise
  • Coverage for behavioral health treatment must be subject to no specific age limit or dollar cap
  • The availability of insurance coverage does not reduce any obligation to provide services under an individualized education program or an individualized service plan
  • Health plans and insurers must maintain an adequate network that includes qualified autism service providers