Update on Autism Insurance Reform Law and ABA Services as of 7/1/2012
May 25, 2012
Effective July 1, 2012, a new State law (Health and Safety Code, Section 1374.73) requires that every health care service plan and health insurance carrier provide coverage for behavioral health treatment services for autism or pervasive developmental disorder. Behavioral health treatment includes applied behavior analysis (ABA) and other evidence-based behavior intervention programs. Consumers receiving health care coverage under Medi-Cal only are exempt from this requirement.
With this change in California Law, effective July 1, 2012, consumers and families will request behavioral services through their health insurance carrier or service plan prior to requesting regional center funding. Regional centers are prohibited from purchasing a service that is available from private insurance or a health care service plan when a consumer or family is eligible for coverage (California Welfare and Institutions Code, Section 4659(c)).
The funds that regional centers receive to purchase services were reduced by $79.8 million due to this change in the law.
If your child has a diagnosis of autism or pervasive developmental disorder and you have private health insurance, you must contact your health insurance provider to request funding for behavioral health services for your child as soon as possible.
To assist consumers and families in accessing insurance services, RCOC has sent a letter to families who are currently receiving regional center funded behavioral services along with other helpful materials. Service Coordinators will be contacting families to discuss the transition to insurance funding.
As always, RCOC is dedicated to meeting the needs of our consumers and families. Please be assured that RCOC will continue to provide behavioral services to eligible individuals and we will make every effort to assist families through this transition from regional center funded behavior services to private health insurance funded behavioral health treatment services.
If you have any questions, please contact your Service Coordinator.