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New California law: Insurers must cover behavior therapy for autism
By Insure.com staff

Insurance companies and health plans will have to cover behavioral therapy for autism under a new California law signed by Gov. Jerry Brown.

But questions remain about whether the mandate will last under federal health care reform.

The requirement, which goes into effect July 1, 2012, will automatically expire July 1, 2014, if the federal government does not include coverage for behavioral therapy among "essential benefits" that health plans must cover under the federal health care reform law.

Brown sounded a less-than-ringing endorsement of the bill in a signing statement.

"While this bill provides relief for families of autistic children and some clarity for health plans, insurers and providers, there are remaining questions about effectiveness, duration and the cost of the covered treatments that must be sorted out," he wrote.

He noted that in deciding what will qualify as essential benefits under health care reform, the Institute of Medicine must strike a balance between making insurance coverage available to people who need care and doing so at an affordable cost, all the while distinguishing between treatments that are medical and those that are not.

"There is still much work to be done," Brown wrote.

Dave Jones, California insurance commissioner, applauded the governor for signing the law.

"Behavioral therapy is widely considered to be an essential and effective method for treating children with autism, and it's a long overdue development for insurers to offer coverage for this treatment," he said in a press statement.

The California Department of Insurance says behavioral intervention therapies, such as applied behavioral analysis, should be considered mandated treatment under California's Mental Health Parity Act.

The California Association of Health Plans estimates the law will increase health care costs in California by almost $850 million a year and sets a precedent for health insurance coverage of non-medical services.

"We agree with the governor that many questions remain unresolved and that much work needs to be done to address our shared concerns about cost and overall healthcare affordability," Patrick Johnston, association president, said in a press statement. "Shifting that non-medical cost burden onto private insurers won't make the cost go away, it will simply make insurance harder to get and less affordable and accessible for millions of Californians."

 

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