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Autism Insurance Settlements Ill-Conceived, Advocates Say

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California officials claimed a win earlier this month after striking deals with two private insurers to cover behavior therapy for children with autism, but now some advocates are calling the settlements a “sham.”

In recent weeks, the California Department of Managed Health Care announced agreements with Anthem Blue Cross and Blue Shield of California under which the insurers said they would provide coverage of applied behavioral analysis, or ABA, therapy.

State officials said the agreements would “provide immediate coverage upfront to potentially thousands of additional children annually” when they announced the plans.

Now, however, some advocates are crying foul. In a joint letter to California Gov. Jerry Brown, six autism and consumer groups said that the settlement reached with Blue Shield — which was soon followed by a similar agreement with Anthem Blue Cross — is inherently flawed.

Specifically, they cite a requirement under the agreements that ABA be administered under the supervision of a licensed provider. This is a problem, they say, because California does not license ABA providers, making finding an approved therapist unlikely for families.

As a result the advocates from the Alliance of California Autism Organizations, Consumer Watchdog and other groups charge in the letter that the requirements “will lead to delays, interruptions and continued denials of treatment.”

Nonetheless, state officials appear to be standing by their actions.

“With the settlements, the (department) opted to take the path which would lead us to immediate coverage for many more children and not bring us back to endless legal challenges or roadblocks from health plans,” Lynne Randolph of the California Department of Managed Health Care told the San Francisco Chronicle.

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  1. eisralowitz says:

    The question is who is a licensed provider? Most states and regional centers who require supervision by a licensed provider consider a BCBA or BCBA-D to be a licensed provider. I think it is essential that such criteria exist and fully support the requirement of a licensed provider. As a classroom teacher and Board Certified Behavior Analyst, I have worked with many ABA providers who have degrees not directly related to autism treatment or ABA. Even if these individuals are good therapists they are often lacking basic behavior knowledge and are not able to design, support and supervise the implementation of behavioral programs. If we want ABA services to be covered by insurance then we need to treat it like any other field of treatment and require certified individuals to supervise and/or provide services. You would not go to a podiatrist for your asthma issues so why would you have a MFT (Marriage and Family Therapist) design and supervise a behavior management program?

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