California insurance plan reaches agreement on autism therapy

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News from California

In an agreement with the California Department of Managed Health Care announced Wednesday, Blue Shield of California will fully cover a certain type of therapy for autism in its insurance plans.

The insurance company had previously argued it should not be required to cover applied behavior analysis therapy, arguing it didn’t qualify as a medical treatment. The therapy is a highly individualized treatment that often requires children to undergo 24 to 40 hours of a week of therapy of a cost as much as $50,000 per year.

“These treatments are the best treatments we have for autism right now,” Dr. Joshua Feder, a psychiatrist and assistant professor at UC San Diego, told the San Francisco Chronicle.

The agreement only applies to Blue Shield members whose health plans are overseen by the state Department of Managed Health Care, which totals about 2.5 million people.

Also on Wednesday, the state Department of Insurance issued an order for Blue Shield to stop denying coverage for the treatment.

The Department argued that by excluding the treatment, Blue Shield was violating the state’s Mental Health Parity Act of 1999, which requires insurers to provide equal coverage for certain mental and physical disabilities, according to an article in the Central Valley Business Times..”

Senate President Pro Tempore Darrell Steinberg (D-Sacrament) has also introduced a bill requiring all California health plans to cover the therapy.

In Washington State, a superior court judge ruled in June that the state’s Mental Health Parity Act requires that the state’s Health Care Authority cover applied behavior analysis therapy.

Since the 1990, the number of people with autism in the United States has skyrocketed from an estimated 1 in 2,500 people to 1 in 110.