The Politics of Autism includes an extensive discussion of insurance.
A release from California State Senator Anthony Portantino:
Senate Bill 562, authored by Senator Anthony J. Portantino (D – La Canada Flintridge), passed the Assembly Health Committee this week. The measure seeks to eliminate barriers to help patients with Autism Spectrum Disorder (ASD) access Behavior Health Treatment (BHT) in California.
“Children need treatment tailored to their individual needs, prescribed by their physician or psychologist who knows them best,” stated Senator Portantino. “SB 562 will allow families to have a choice of intervention approaches in a timely manner. Early intervention is the key to helping children live up to their potential and health insurance coverage for behavioral health treatment is critical.”
Current law requires that health insurance companies cover all physician or psychologist prescribed medically necessary, evidence-based BHT for ASD. Due to a loophole in the law, patients with ASD are being denied coverage for physician and psychologist prescribed evidence-based BHT. In some cases, coverage is only being offered for one form of BHT. A shortage of network providers has also created a six to twelve month wait list for BHT services.
Additionally, all BHT providers are constrained by other statutory provisions that serve to allow insurance denials. These include the requirement for parental participation and restraints on the location. Children of working parents can be denied coverage for medically necessary treatment simply because the parent has to work and cannot attend every treatment session. Similarly, if a child must receive treatment at an after-school daycare location, they can be denied coverage simply because the setting is at a school.
If signed into law, SB 562 will eliminate the existing statutory obstacles and require health insurance coverage for all forms of medically necessary, evidence-based BHT for Californians with ASD without diminishing consumer protections. The measure expands the number of qualified professionals by authorizing already State certified professionals to administer BHT within their professional competence, thereby reducing or eliminating the waiting list for services.
SB 562 also details the requirements for a Qualified Autism Service Paraprofessional to insure health insurance coverage, including background checks to protect California children. The measure will protect the interests of California consumers and the state by closing the loopholes in the law and ensuring that every Californian is covered.
“It is great to see that SB 562 is successfully moving toward adoption,” stated Dr. Diane Cullinane, Co-Founder and Executive Director Emerita of Professional Child Development Associates, a non-profit organization located in Pasadena. “This legislation will be a tremendous benefit for children with autism and their families. By ensuring that insurance will cover all effective treatments, families will finally have a choice of types of intervention, and broader access to service providers. We appreciate Senator Anthony Portantino for his tireless advocacy for people with disabilities.”
SB 562 is sponsored by the DIR/Floortime Coalition of California, Professional Child Development Associates, and Cherry Crisp Entertainment and Productions. Supporters of the bill include: Center for Developmental Play and Learning, Child Development Institute, Dr. Barbara Stroud, Clinical Psychologist, Fresno City College, Greenhouse Therapy Center, Holding Hands Pediatric Therapy and Adult Services, NeuroRelational Framework Institute, Positive Development, the Washington Elks Therapy Programs for Children, INC., and Touchstone Family Development Center.
BHT treatment can also be described as a continuum from treatment modalities based primarily on behavioral theory (often referred to as applied behavior analysis - ABA) to treatments based primarily on developmental theory. Existing law explicitly requires coverage for BHT treatment modalities based on behavioral theory. This bill would amend existing law to explicitly require coverage for BHT treatment modalities based on developmental theory. Treatments based on behavioral theory (ABA) fall at the behavioral end of the continuum.
Examples at the developmental end include RDI and Floortime.