In October 2011, California Governor Jerry Brown signed into law Senate Bill 949 requiring that all fully insured medical plans written in California provide behavioral treatment therapies related to autism. This mandated coverage will appear in your health plan beginning with July 1, 2012 group health plan renewals and plan renewals after that date. By June 1, 2013, all fully insured plans are required to include the mandated autism benefit.
The details of the bill require that all fully insured health plans provide coverage for those with an autism spectrum disorder which includes Autistic Disorder, Asperger's Syndrome, and Pervasive Developmental Disorder. Health plans will be required to provide coverage for evaluation and assessment of autism, medical management, rehabilitation therapy and individual and family psychotherapy. In addition, plans will need to cover applied behavior analysis and other evidence-based behavior intervention programs. These benefits must be provided with no caps on age or level of benefits. Refer to your health carrier's summary of benefits for details on their autism benefit.
The mandated autism coverage is a welcomed benefit for the estimated 30,000 children in California diagnosed with autism. It is also welcomed financial relief for families who, on average, incur $50,000 in costs for behavioral treatment each year. Families have had to pay the full cost of these treatments as an out-of-pocket expense or apply to receive support through tax-payer funded government programs.
Advocates of the legislation applauded the passing of this bill because it will result in more children having access to care. Studies show that early intervention treatments, such as applied behavior analysis, can substantially increase a child's independence now and as an adult.
Proponents of the legislation estimate this new coverage will cost insurance carriers in California an additional $850 million a year. The mandate will increase the cost of individual and group health plan premiums putting additional financial burden on employers and employees. We have already seen many insurance carriers increase their individual plan premiums. Employer sponsored plans will see the same impact on premium as their fully insured medical plans renew in the next 12 months.
It is important to note that this law is subject to expire on July 1, 2014. We will continue to see in the coming years whether this mandate is extended with the pending rollout of National Healthcare Reform.