A California appellate court has ruled that the California Department of Managed Health Care ("DMHC") must direct health plans within its jurisdiction to provide coverage for Applied Behavioral Analysis ("ABA"), an intensive form of therapy often used to treat the symptoms of autism in young children, when provided or supervised by Behavior Analyst Certification Board ("BACB")-certified therapists who are not otherwise licensed as physicians, psychologists, or otherwise.
The California Statute
As of July 1, 2012, California Health and Safety Code Section 1374.73 (the "ABA statute"), enacted by the legislature on October 9, 2011, provides that health plans are required to:
provide coverage for behavioral health treatment for pervasive developmental disorder or autism.
Health & Saf.Code, § 1374.73, subd. (a)(1), italics added.
The law defines:
Behavioral health treatment
to include various treatment programs, including ABA. Health & Saf.Code, § 1374.73, subd. (c)(1).)
The law defines a:
qualified autism service provider
as a person either licensed under California law (as a physician, psychologist, occupational therapist, or one of several other enumerated professionals) who designs, supervises, or provides treatment for pervasive developmental disorder or autism, Health & Saf.Code, § 1374.73, subd. (c)(3)(B)), or:
certified by a national entity, such as the [BACB] and who designs, supervises, or provides treatment for pervasive developmental disorder or autism.
Health & Saf.Code, § 1374.73, subd. (c)(3)(A).
It defines a:
qualified autism service professional
as anyone approved: