It’s hard to find a family that has not been touched by the diagnosis of Autism. It’s epidemic spread not only causes devastating concern for families but the financial implications are extreme. Federal and State educational programs are only spread so thin before resources run dry for many. Even with Federal and State Mental Health Parity Laws, the insured public continues to fight on a daily basis for therapies to help their children.
As insurance agents engaged in this daily fight, we welcome this clarity of coverage. Our agency has always worked as an advocate for our clients to get the most out of their policies and to provide as much covered care as possible. Help is arriving in California on July 1, 2012 in the form of SB946. SB946 (aka. Mental Illness: Pervasive Developmental Disorder) will add coverage for Behavioral Health Treatment (BHT).
The technical definition of BHT is “professional sevices and treatment programs, including applied behavior analysis and evidence-based intervention programs that develop or restore, to the maximum extent practicable, the functioning of an individual with pervasive development disorder or autism.” Coverage must be prescribed by a licensed physician and pre-authorized by the health plan. It will cover treatment in non-institutional and home settings as well as in-office services.
In addition to mandating coverage for autism treatment, the bill requires the creation of the Autism Advisory Task force. Advocates for Autism issues will be well represented on this board. “Autism Speaks” Vice President, Lorri Unumb was named as a member of this important task force. “I am honored to serve on this task force and to contribute to making California’s autism insurance reform law one of the most effective in the nation,” said Unumb. “Autism Speaks welcomes this opportunity to work with the DMHC.”
California insurers will begin mailing notices to all policyholders over the next month to provide information on this important July 1, 2012 amendment. The bill also mandates that insurers provide adequate access to providers that will be able to provide these services. This will help to assure policyholders that covered services will also be made more available.
When an employee is dealing with this family issue they are very often pulled away from work. They may spend hours on the phone fighting for coverage approvals and provider access. Employers are paying the price for this lack of “presenteeism” in these employees. We look forward to educating employers and employees on the benefits of this new law and how proper Wellness and Employee Assistance Programs can work together to provide the best outcome when dealing with the issues affected by this new law.
Paula L. Wilson, RHU, REBC is principal of Paula L. Wilson, Inc., an Employee Benefits Firm. Employers are encouraged to contact Paula at 888-447-2852.
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