|Public Policy and Practice | Update: July 19, 2011|
CalABA in the News and at the Capitol
The California Senate Select Committee on Autism and Related Disorders, chaired by Senate President pro Tem Darrell Steinberg (D-Sacramento), held an informational hearing on Wednesday, July 13, 2011 to discuss the inconsistencies in health insurance coverage of behavioral health treatments for individuals with Autism Spectrum Disorders (ASD). A similar hearing was held in 2010 but some positive differences were evident this year. For example, the following themes were repeated throughout the hearing:
California's Department of Insurance headed up by Commissioner Dave Jones and Deputy Commissioner Patricia Sturdevant submitted a particularly strong position paper on these points to the Senate Committee. Click here to read the Department of Insurance's July 13 press release announcing enforcement action against Blue Shield for denying coverage of ABA treatment for autism. Other advocates and professionals including Areva Martin, Founder and President of Special Needs Network, spoke eloquently about the need for ABA services for individuals with ASD and the struggles of families to obtain this critical treatment.
Brianna Lierman Hintze, CalABA lobbyist, also spoke and identified CalABA as the provider pool for ABA services. She underscored CalABA's desire to work with Senator Steinberg and other legislators, parents and advocates, the Department of Managed Health Care (DMHC), and the Department of Insurance, to provide solutions to coverage problems.
An announcement was made at the hearing of a settlement between the DMHC and Anthem Blue Cross and similar pending agreements with Blue Shield and Kaiser to cover ABA treatments.* However, the Anthem settlement requires that ABA services be supervised by a licensed provider.**
Thus, it is no surprise (to CalABA members) that one focal point of the hearing became ABA provider qualifications. Lorri Unumb, Autism Speaks Vice President for Government Services, Gina Green, Executive Director of the Association of Professional Behavior Analysts, and Jerry Flanagan, Staff Attorney for Consumer Watchdog, as well as several parents noted that the DMHC's settlement with Anthem (and any others structured similarly) will still leave many families without services as behavior analysts are not licensed in California. As Autism Speaks observed,
"Reading the fine print of the settlement revealed this: it requires ABA to be supervised by a licensed provider, but no license exists in California for behavior analysts (the professionals who supervise ABA). So under this agreement, Board Certified Behavior Analysts -- the people who are trained to design and know how to supervise ABA -- cannot do so, while people who happen to be licensed in something, but have no knowledge of behavior analysis, can."
Autism Speaks also applauded Senator Steinberg's and Assembly Member Beall's leadership regarding thoughtful and comprehensive insurance reform in California. Click here to read the Autism Speaks press release in its entirety.
Keep in close touch. More developments are expected. CalABA will be working to help members and California BCBAs navigate the road ahead.
*California has two regulatory bodies charged with overseeing that health plans operate within statute and regulation. The California Department of Insurance oversees non-HMO health plans. The Department of Managed Health Care (the focus of last year's lawsuit by Consumer Watchdog) regulates HMO health care. The majority of California's children are served by HMOs.
**The LA Times ran an
article about the Anthem/DMHC settlement
and the call for insurance reform but provided an inaccurate definition of ABA services. CalABA has
written the authors of this story and expressed our appreciation for their role in
promoting awareness of these issues. But we also requested that an accurate definition of ABA be
provided to the readers of the LA Times. CalABA has also offered itself as a resource to the staff writers.
Go to http://calchannel.com/channel/viewvideo/2851 (Part 1 of 2) and http://calchannel.com/channel/viewvideo/2852 (Part 2 of 2) to view the hearing in its entirety. If you do so, please send your comments to email@example.com. We want to hear from you!!!