Administrative Law Office OKs Autism Measures

by David Gorn

TOPIC ALERT:

The California Office of Administrative Law on Monday approved emergency regulations governing health insurers' treatment of autism coverage.

The regulations were issued by the Department of Insurance to implement details of the California Mental Health Parity Act as well as to implement SB 946 by Sen. Darrell Steinberg (D-Sacramento), an autism treatment law passed in 2011.

"These emergency regulations will ensure that insurance companies cover medically necessary treatment," Insurance Commissioner Dave Jones said in a written statement. "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."

Although laws were in the books governing autism coverage, consumer complaints raised concerns at the Department of Insurance that some insurance carriers might not be complying with the laws. The emergency regulations should clarify the laws' requirements, said Janice Rocco, deputy commissioner at DOI.

"We found that it was important to get these [emergency] regulations in place as soon as they were drafted," Rocco said. "Any delay can impact a child in an ongoing way. If you have delay, [the condition] becomes more difficult to treat, and more costly to treat."

State law on autism treatment is a different issue from autism coverage under the essential health benefits of the Affordable Care Act, Rocco said.

"The federal law will require certain coverage, but state law is different. In California, we have put more comprehensive solutions into statutes," Rocco said.

Jones said autism has reached "crisis proportions" in California, and that delays or denials by health insurers in covering autism treatment ends up increasing costs to the state, as patients end up seeking help at the county or state level. According to Jones, California will save between $139 million and $198 million next year, as insurers pick up the cost of autism treatment.

The OAL approval of the Department of Insurance emergency regulations  went into effect Monday.

The emergency regulations ban visit limits and end cost limits on coverage  unless limits apply equally to all benefits under the policy. They also limit denials and unreasonable delays in coverage.


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