In California, Autism Coverage Precedes Specific Legislation

This agreement does not constitute an admission of liability, violation, wrongdoing or improper conduct, it states. The CDI had filed an enforcement action against Blue Shield in July 2011 seeking compliance with the state's Mental Health Parity Law, which requires coverage for medically necessary behavioral therapies, including Applied Behavior Analysis Therapy (ABA), a well- recognized treatment for autism. 

The Department had served Blue Shield with an Order to Show Cause and Statement of Charges and Notice of Monetary Penalty, which appears to have been avoided under the terms of the settlement.

Blue Shield agreed to stop denying ABA therapy as a non-covered service, challenging the medical necessity of ABA therapy and to stop forcing parents into an unnecessary Independent Medical Review to secure treatment

 Blue Shield has agreed to establish a dedicated customer service unit to respond quickly to inquiries from families seeking approval of medically necessary ABA therapy, and to pay for services at the higher in-network benefit levels.

"By taking this action, the Department of Insurance has put the entire health insurance industry in California on notice that denials of coverage for behavioral health treatment, including ABA therapy, must stop," said Commissioner Jones. "Existing state law requires and has required health insurers to provide coverage for autism—we will continue to vigorously enforce that law and expect other health insurers to comply immediately."

Health insurers had sought to recharacterize the Legislature's intent in passing SB 946 by arguing that its passage means they were not required previously to provide autism coverage, the Department charged.