SACRAMENTO (March 12, 2013) -- A state judge has given the California Department of Insurance the go-ahead to institute emergency regulations preventing state-regulated health insurers from limiting visits or costs for ABA treatment for autism. Proposed in response to widespread complaints of delays and denials in accessing ABA treatment, the emergency rules became effective March 11, impacting an estimated 42,000 children with autism.
"I am extremely pleased that the Office of Administrative Law has approved our emergency regulations," said Insurance Commissioner Dave Jones [right]. "These emergency regulations will ensure that insurance companies cover medically necessary treatment required by the Mental Health Parity Act and Senator Darrell Steinberg's (2011) autism treatment legislation.
"Autistic children and their families should now, without delay, receive the transformative treatment that will enable them to succeed in school, their families, and communities," he said
Jones proposed the emergency regulations in February by declaring autism a public health crisis. He said denials and delays by health insurers in approving Applied Behavior Analysis (ABA) treatment were making the crisis worse.
The department said the insurance industry's actions failed to comply with California's 1999 Mental Health Parity Act and the 2011 autism insurance reform law sponsored by Senator President pro Tem Darrell Steinberg. The regulations specifically:
- prohibit visit limits on coverage
- prohibit dollar limits on coverage, unless they apply equally to all benefits under the policy
- prohibit denials or unreasonable delays for behavioral health treatment on the basis of a claimed need for IQ testing, or on the grounds that such treatment is experimental, investigational, or educational, or would not be provided or supervised by a licensed individual, provided that individual is certified by a national accredited entity such as the Behavior Analyst Certification Board
The action is expected to divert between $138.8 million and $197.8 million in treatment costs over the next year from taxpayers to insurers. The department determined that 42,000 California children between the ages of 3 and 21, including 8,500 children between the ages of 3 and 5, would be directly affected.
Jones said the Insurance Department, since January 2011, had received 71 complaints, reflecting cumulative delays of 12,864 days, or 35.2 years, in obtaining medically necessary treatment. The State Council of Development Disabilities reported that children transitioning from Regional Center services to private ABA treatment providers had been forced to wait over three months to begin receiving services.