Feedback needed on your experience with SB 946


Matrix blogged last summer about a new law, SB 946 that went into effect July 1, 2012 (Know Your Rights — Health insurance must cover autism) which mandates that insurance must cover behavioral health treatment for autism.

Directors of several Area Boards in southern California are meeting with the Department of Managed Health Care on December 4, 2012 and working with the Office of Clients Rights’ Advocacy and Disability Rights California to address concerns families may have about the implementation of SB 946.  In order to best represent the concerns of those who are impacted by SB 946, they are requesting your feedback.  Your feedback is welcome even after the December 4 meeting date has passed.  Please reply to this survey if you and your family have had challenges in the following areas:

  • Co-pays
  • Delays in the start of services
  • Choice in terms of providers
  • Co-Insurance
  • Other issues

Survey Link:

Know Your Rights — Health insurance must cover autism

Consumer AlertThe California Department of Insurance reminds consumers a new law took effect July 1, 2012, mandating that health insurers cover behavioral health treatment for autism. This new law reconfirms provisions of California’s Mental Health Parity Act.

Know Your Rights To Autism Treatment:

  • Every health insurance contract that provides hospital, medical, or surgical benefits must also provide coverage for behavioral health treatment (BHT) for pervasive developmental disorder or autism. BHT includes Applied Behavioral Analysis (ABA) and other evidence-based therapies to treat autism.
  • Every health insurer must maintain an adequate network that includes qualified autism service providers.
  • The treatment plan must be prescribed by a licensed physician, or surgeon, or developed by a licensed psychologist. Start by working with your child’s primary care provider to learn about appropriate services.
  • The treatment plan must have measurable goals over a specific timeline, be reviewed every six months, and must not be used for the reimbursement of respite, day care, or educational services.
  • Health care insurers may require prior authorization, copayments, or other cost-sharing for BHT.
  • Visit limits may not be imposed for medically necessary speech or occupational therapy for autism.
  • Even if the policy excludes or limits these types of treatment, the law entitles insureds with autism to coverage for all medically necessary behavioral, speech, and occupational therapy.

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