UnitedHealthcare, DOI Reach Settlement on Autism Therapy

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On Monday, California Insurance Commissioner Dave Jones (D) announced a settlement agreement with UnitedHealthcare in which the insurer agreed to immediately cover specialized therapy for people with autism, the Sacramento Business Journal reports.

The agreement follows similar settlements with Blue Shield of California, Cigna and Health Net. Anthem Blue Cross has been providing coverage under direction by the Department of Insurance since late 2009 (Robertson, Sacramento Business Journal, 4/17).

The settlements stem from a dispute over the insurers' compliance with the state's Mental Health Parity Law, which mandates coverage of medically necessary behavioral therapies.

Background

The therapy -- called applied behavior analysis or behavioral intervention therapy -- typically consists of intensive sessions with a therapist who uses conditioning techniques to help influence behavior.

Many insurers have denied coverage for the therapy, arguing that it is not a medical service and that health plans are not required to cover it by law (California Healthline, 2/1).

Last year, Gov. Jerry Brown (D) signed a law (SB 946) that requires all plans as of July 1 to cover the therapy for autism and similar conditions.

Settlement Details

As part of the settlements, the insurers have agreed to:

  • Maintain an adequate provider network;
  • Establish a dedicated customer service unit with specially-trained staff; and
  • Provide policy information about screening, diagnosis and treatment.

In a statement, Jones said, "We are pleased UnitedHealthcare joins four other insurers in fulfilling its responsibility to provide this necessary and vital treatment to the state’s thousands of autistic children."

Pending Lawsuit

Meanwhile, a lawsuit alleging that state regulators do not have authority to require coverage of the therapy is on hold in Sacramento County Superior Court.

Nicole Kasabian Evans -- a spokesperson for the California Association of Health Plans, which filed the lawsuit -- said, "Health plans continue to maintain ABA is educational in nature and not required until SB 946 takes effect" (Sacramento Business Journal, 4/17).


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