On Wednesday, a Sacramento Superior Court judge issued a preliminary ruling that denies an attempt by HMOs to receive a quick decision as to whether health insurers must cover a certain autism treatment, the Sacramento Business Journal reports.
The matter will move to trial if the tentative ruling holds following a limited argument in court on Thursday.
Background
The case involves a therapy known as applied behavioral analysis, or ABA. The treatment teaches children with autism and similar conditions how to eat, learn and play.
Insurers consider ABA as an educational therapy rather than a medical treatment.
In October, the California Association of Health Plans filed a lawsuit claiming that only lawmakers, not the state Department of Managed Health Care, can mandate a new insurance benefit. The association asked for a speedy adjudication of the issue or a summary judgment.
Meanwhile, DMHC in July announced deals with Anthem Blue Cross and Blue Shield of California to extend coverage to policyholders who request the therapy until the issue is settled.
Details of the Ruling
Judge Shelleyanne Chang concluded that the insurance association did not satisfy the burden of proof that the law is clear on the issue of coverage. She noted that there are disputed matters and that the lawsuit should proceed.
Chang said DMHC has established the existence of a "triable issue" on five facts, thereby requiring denial of a summary judgment.
Reaction
Nicole Evans -- a spokesperson for the California Association of Health Plans -- said, "Essentially, the court decided to delay making a decision without addressing the subject of the lawsuit."
Evans said the association will keep pursuing the lawsuit.
DMHC officials were reviewing the ruling and did not issue a comment (Robertson, Sacramento Business Journal, 8/24).