California makes it harder for insurers to deny autism treatment

SACRAMENTO, California Thu Apr 17, 2014 6:54am IST

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SACRAMENTO, California (Reuters) - California on Wednesday made it harder for health insurers to deny or delay coverage of key interventions for children with autism, the latest in an ongoing series of actions by U.S. states to help families obtain the expensive therapies.

In tightening its rules on covering behavioral intervention for children with autism, California is tackling a problem encountered by numerous states seeking to improve access to therapies for children with autism, the state's top regulator said.

"The insurance companies deny the treatment, or they delay, delay, delay," California Insurance Commissioner Dave Jones said in an interview.

The new rules make it clear that insurers must cover behavioral interventions for children with autism at the same level that they cover visits to a medical doctor, Jones said.

California enacted its first law requiring insurers to cover therapies for autism, including speech and behavioral intervention, in 2011, Jones said, making the state the 28th in the nation to do so.

The therapies help children learn how to speak, improve their abilities to process ideas and language, and interact socially. Started at a young age, they are widely believed to help children who in the past might have been left behind.

But Jones said that state regulators across the nation have since complained that many insurers are finding a way around their laws.

For example, he said, some insurance companies require behavioral therapies to be administered by a medical doctor in order to be covered. But the therapies are not typically provided by doctors, so the requirement was actually a way to deny the claims, he said.

"Now I'm pretty confident that we can put a stop to all that," Jones said.

Autism Speaks, an advocacy organization for people with autism spectrum disorders, has closely tracked the state initiatives, and said that even with the loopholes cited by Jones, California's law has helped 12,500 children since 2011.

A spokeswoman for the California Association of Health Plans said that the organization would not be able to comment on the new rules on Wednesday. A spokesman for Anthem Blue Cross deferred to the California Association of Health Plans.

As many as one in 68 U.S. children have autism, a 30 percent increase in just two years, U.S. health officials said last month, but experts think the rise may simply reflect that parents and doctors are getting better at recognizing and diagnosing the disorder.

The latest report by the U.S. Centers for Disease Control and Prevention, which looks at data from 2010, estimates that 14.7 per 1,000 8-year-olds in 11 U.S. communities have autism. That compares with the prior estimate of 1 in 88 children, or 11.3 of 1,000 8-year-olds, in 2008, and 1 in 150 children in 2000.

Autism encompasses a spectrum of disorders, ranging from a profound inability to communicate and mental retardation to relatively mild symptoms in people with very high intellectual ability.

(Editing by Eric Walsh)

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