At AP, Judy Lin reports on action in California:
The state Assembly on Thursday passed a set of bills intended to broaden the mental health and health care services covered by private insurance plans.
Lawmakers approved AB154, which would require insurers to cover the diagnosis and treatment of mental illnesses, and AB171 for coverage of developmental disorders such as autism. They also approved legislation to cover oral chemotherapy treatments and mammograms regardless of age.
The bills now move to the Senate ahead of a Tuesday deadline to pass legislation that was introduced last year.
From the Assembly bill analysis:
According to the author, this bill is intended to confirm existing law and close perceived loopholes that health plans and insurers exploit to deny essential treatment to individuals with PDD/A. The author maintains that, by explicitly listing medically necessary health care services that must be covered for PDD/A, this bill confirms the coverage in the existing mental health parity law and basic health care service requirements and will significantly reduce the need for the DMHC and CDI to overturn continually erroneous coverage denials by plans and insurers. The author points out that requiring health plans and health insurers to cover screening, diagnosis, and treatment of PDD/A and to develop and maintain networks of qualified PDD/A service providers will force them to bear their fair share of the responsibility for providing essential and comprehensive treatment to the families in California impacted by these conditions. The author adds that this bill is intended to complete the end of insurance discrimination against individuals with PDD/A that was started in 2011 with the enactment of SB 946 (Steinberg), Chapter 650, Statutes of 2011, which dealt with behavioral health treatment by addressing screening diagnosis and the remaining essential medical treatments for PDD/A, such as speech, physical and occupational therapy, which are routinely denied despite clear coverage requirements in existing law.
The official digest of AB 171:AB 171, as introduced, Beall. Autism spectrum disorder. (1) Existing law provides for licensing and regulation of health care service plans by the Department of Managed Health Care. A willful violation of these provisions is a crime. Existing law provides for licensing and regulation of health insurers by the Insurance Commissioner. Existing law requires health care service plan contracts and health insurance policies to provide benefits for specified conditions, including certain mental health conditions. This bill would require health care service plan contracts and health insurance policies to provide coverage for the screening, diagnosis, and treatment of autism spectrum disorders. The bill would, however, provide that no benefits are required to be provided by a health benefit plan offered through the California Health Benefit Exchange that exceed the essential health benefits required under federal law. The bill would prohibit coverage from being denied for specified reasons. Because the bill would change the definition of a crime with respect to health care service plans, it would thereby impose a state-mandated local program. (2) The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement. This bill would provide that no reimbursement is required by this act for a specified reason. Vote: majority. Appropriation: no. Fiscal committee: yes. State-mandated local program: yes.
