California SB 946 (Steinberg) requires Private Health Plans and Insurance Companies to provide coverage for behavioral health treatment (BHT) for individuals with autism or pervasive developmental disorders. BHT treatment must meet the standards set out in the bill. The new law is effective from 7/1/2012 and expires on 7/1/14. If the Federal government does not establish Autism behavioral health treatment as a "essential health benefit", this bill will automatically expire on 7/1/14.
Please pass this legislation on to your teachers, support staff, administrators and parents. This law may encourage a pediatrician to refer in house for diagnosis of Autism, as the insurance company can no longer deny BHT. Early treatment and medical identification is critical, especially when some families do not contact the Regional Center. If services are not offered by insurance companies when requested by families, the family could file a complaint with the Department of Managed Health Care as a "willful violation of these provisions which is considered a crime". If the child qualifies for Regional Center Services, the regional center is already billing insurance for reimbursement of medical and mental health services (behavior health treatment).
The Mental Health Parity Law Protects Certain Conditions
A health plan must cover the same or equal benefits for certain mental health conditions that it covers for other medical conditions. This is called "mental health parity." It is a law in California. For example, if your plan offers prescription drug benefits, whether drugs are prescribed for a mental health or medical condition, they must be covered at the same rates. The co-payments, deductibles, and maximum lifetime benefits charged for mental health conditions must be the same as those for medical conditions.
The Mental Health Parity Law ensures the same medical care coverage for the following mental health conditions:
- Major depression
- Bipolar (manic-depressive) disorder
- Panic disorder
- Obsessive-compulsive disorder
- Autism or Pervasive Developmental Disorder
- Schizoaffective disorder
- Children's severe emotional disturbances
Know Your Rights (patient or parent rights)
- You have the right to coverage for the diagnosis and medically necessary treatment of severe mental illness under the mental health parity law.
- You can change your doctor or other mental health provider if you are not satisfied.
- You can see and get a copy of your medical records. You can add your own notes to your records.
- You have the right to keep your medical information private.
- You can get a second medical opinion when you are given a diagnosis or treatment option.
- Read more information about your health care rights.
How to Get Care
You can ask for a referral from your primary care doctor, your mental health care provider, or your health plan. In some plans, you may be able to make an appointment directly with a mental health care provider. Read your Evidence of Coverage (a booklet about your benefits) or call the phone number on your Membership Card to find out what you need to do to see a mental health provider. Some plans have a behavioral health care phone number on the membership card. You can call this number.
Mental health care can include:
- Screening or diagnostic tests, to identify a mental health problem.
- Hospital care, either for a number of overnight days, or just during the day.
- Prescription drug benefits.
- Counseling or therapy for individuals, children, families, and couples.
- Group counseling or therapy.
DSM-V proposed revisions:
Articles of interest:
Invitation to Preview Autism Resource Guide
I cordially invite you to preview my award-winning book, A Best Practice Guide to Assessment and Intervention for Autism and Asperger Syndrome in Schools. Filling a critical void in the autism literature, this authoritative yet accessible text provides school psychologists, special educators, support professionals, advocates, and parents with a best practice guide to screening, assessment, and intervention for school-age children with autism spectrum disorders (ASD). Grounded in the latest research, special features include illustrative case examples and an index to 50 evidence-based best practice recommendations. This book also makes an ideal text for graduate-level training courses in special education and is certain to become a widely used resource.
The free preview is available at: <http://books.google.com/books?printsec=frontcover&id=cwyGUFkMFDoC#v=onepage&q&f=false>
Thanks for your time.
Lee A. Wilkinson, PhD, NCSP