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Monday, July 2, 2012

Limits of the CA Mandate

But even though the goal was to make the intervention available to most Californians through their insurance, many plans will not offer it. That’s because most of the largest employers are exempt from state requirements under a 1970s-era law that was actually meant to protect privately funded pension plans.
The law says that any company that is self-insured – meaning that they pay for the care that their employees through a fund they’ve set up to handle those expenses – are subject to federal regulation, but exempt from many regulations imposed by the states.
Most large employers fall into this category, which means that covering behavioral therapy for autism will be voluntary for them.
Some large companies have decided to comply with the law anyway, said Tammy Pederson, director of insurance for Trumpet Behavioral Health. But many have not. 
“There’s starting to be huge pressure on companies to cover this,” Pederson said. “But it’s absolutely voluntary. They do it because the families need it.”
Pederson, who is working with NBC4 to staff a call-in line for viewers trying to find out more about behavioral therapy and the new law, said it’s important for families facing expensive deductibles and co-payments to go back to their local regional centers to see if they can get financial assistance.
The regional centers, meanwhile, have been told by state lawmakers that it would be illegal for them to fund behavioral services for people who are covered under their insurance.
So thousands of families received notifications in June that they will be dropped from the state-funded program unless they can show that they are not covered.
Even more confusing, each regional center is responsible for implementing its own version of the law, so there is no clear answer to questions about whether there will be help with co-payments, or whether services will be interrupted as children transition from state-provided benefits to private ones.