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Tuesday, September 6, 2011

California Case on ABA

Kathy Robertson writes at The Sacramento Business Journal:

A tentative ruling that denies an attempt by the HMO industry to get a quick resolution over whether health plans must cover a controversial and expensive treatment for autism patients will stand for now.

On Wednesday, a judge found that theCalifornia Association of Health Plans didn’t satisfy its burden of proving the law is clear on the issue, and that the lawsuit should continue.

The CAHP did not request a hearing Thursday, so Sacramento Superior Court Judge Shelleyanne Chang’s ruling will stand. No new court dates have been set.

The trade group had asked for a summary judgment or quick adjudication of the issues. The association filed a lawsuit against the state Department of Managed Health Care in October, alleging the agency has no authority to mandate a new benefit, only legislators do.

On Thursday, a DMHC spokeswoman said the ruling was in the best interests of the public.

Lynne Randolph of the DMHC said in a statement that the ruling affirms the department’s ability to provide access to “medically necessary services, consistent with the law and health plan contracts.”

At issue is a promising but expensive therapy called applied behavioral analysis. Known as ABA, the therapy teaches young children with autism and similar disorders how to eat, play and learn.

Advocates of ABA would disagree with the idea that it is controversial, though it does have its critics.