Autism Organizations Back Insurance Reform in California

February 3, 2011
By Amanda Glensky

Bill introduced in the California Assembly increases access to healthcare for persons with autism

FOR IMMEDIATE RELEASE

Media Contact:

Amanda Glensky, Media Specialist
aglensky@autism-society.org
301-657-0881 x9015

Autism Organizations Back Insurance Reform in California
Bill introduced in the California Assembly increases access to healthcare for persons with autism

Bethesda, MD (February 3, 2011) – The Alliance of California Autism Organizations (ACAO) is calling on autism advocates across the state to support Assembly Bill 171 (Beall), a bill that would reform insurance coverage and end discrimination against individuals with autism in California. Sponsored by  Assembly Member Jim Beall Jr. (D-San Jose), the bill would allow California families living with autism to  access medically necessary treatments.

“The Autism Society is fully behind the efforts of ACAO and Rep. Beall Jr. as they mobilize to improve the lives of all affected by autism in California,” Autism Society President and CEO Lee Grossman said. “We  feel this bill would provide the necessary protections and access to medical services for people on the  spectrum, so they can stop being discriminated against by the health insurance industry and start  getting the medical services they need to reach their full potential.”

ABOUT ASSEMBLY BILL 171:

Requires health insurance companies to cover screening, diagnosis and treatment of autism spectrum  disorders.

Prohibits health insurance companies from terminating coverage or refusing to deliver, execute, issue,  amend, adjust, or renew coverage to an enrollee solely because the individual is diagnosed with, or has  received treatment for, an autism spectrum disorder.

The bill has no arbitrary cap on age, number of visits or an annual benefit dollar limit.

The bill prohibits lifetime caps, deductibles, copayments, or coinsurance or other terms and conditions that are less favorable than those that apply to physical illness generally under the health plan.

The bill requires health plans to establish and maintain an adequate network of qualified autism service
providers.

Coverage of treatments will be provided when prescribed, provided, or ordered for an individual diagnosed with autism by a licensed physician or a licensed psychologist who determines the care to be medically necessary including:


• Diagnosis of an autism spectrum disorder -meaning medically necessary assessments evaluations, or tests to diagnose whether an individual has one of the autism spectrum  disorders.

• Behavioral health treatment -meaning professional services and treatment programs, including behavioral intervention therapy, applied behavioral analysis (ABA), and other intensive
behavioral programs, that have demonstrated efficacy to develop, maintain, or restore, to the maximum extent practicable, the functioning or quality of life of an individual and that have been demonstrated to treat the core symptoms associated with autism spectrum disorder.

• Pharmacy care, psychiatric care, psychological care and therapeutic care -meaning services provided by licensed or certified speech therapists, occupational therapists, or physical therapists.

• Any care for individuals with autism spectrum disorders that is demonstrated, based upon practices or evidence-based research, to be medically necessary. The bill does not affect any obligation to provide services to an individual under an individualized family service plan, an individualized education program (IEP), or an individualized services plan.

The bill applies only to state regulated private insurance plans. It does not apply to self-funded insurance plans which are regulated by the federal government under ERISA law.

When passed, the bill would go into effect for every health insurance policy issued, amended, or renewed on or after January 1, 2012.

ABOUT THE ALLIANCE OF CALIFORNIA AUTISM ORGANIZATIONS:

ACAO, an alliance of over 40 California-based local, state, and nationally affiliated autism organizations, believes meaningful health insurance reform is necessary for the well-being of all individuals with autism and their families. For more information, contact former Autism Society National Board Member Rick Rollens at rollensconsult@aol.com or 916-412-2797.

ABOUT THE AUTISM SOCIETY:

The Autism Society, the nation’s leading grassroots autism organization, exists to improve the lives of all affected by autism. We do this by increasing public awareness about the day-to-day issues faced by people on the spectrum, advocating for appropriate services for individuals across the lifespan, and providing the latest information regarding treatment, education, research and advocacy. For more information, visit www.autism-society.org.

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