New emergency rules won’t let insurers illegally limit therapy visits.(shannonrosa/flickr)
California regulators have issued emergency regulations aimed at keeping insurance companies from delaying or denying coverage for autism treatment.
Insurance Commissioner Dave Jones announced the approval of emergency rules this week, which take effect immediately.
“Autistic children and their families should now, without delay, receive the transformative treatment that will enable them to succeed in school, their families, and communities,” Jones wrote in a statement.
Insurers have already been required to comply with medically necessary treatment by the state’s Mental Health Parity Law and SB 946, which reinforced the mandate for private insurers to provide behavioral treatment for autism.
However Karen Fessel, executive director of the Northern California-based Autism Health Insurance Project, says these emergency regulations were needed.
“This is an example how even with the right laws in place you still need vigilant regulators who will help interpret the law in ways that they were intended,” says Fessel “Because the health plans often twist things around so much people don’t get the care they need even with the laws.” Continue reading
The court upheld its decision on coverage for anorexia (Flickr/Rega Photography)
A closely watched case testing California’s Mental Health Parity law has withstood a call for a rehearing.
The Courthouse News Service reports that this week the U.S. Ninth Circuit Court of Appeals upheld its decision from August 2011 requiring Blue Shield to cover one woman’s treatment for anorexia under state law, even though it wasn’t spelled out in her policy.
The 9th Circuit refused Monday to reconsider a ruling ordering Blue Shield of California to pay for a severely anorexic woman’s long stay in a residential treatment facility, despite a strong dissent by one judge.
A three-judge panel of the San Francisco-based federal appeals panel ruled last year that California’s mental-health parity law required Blue Shield to pay for Jeanene Harlick’s nine-month stay in Missouri’s Castlewood Treatment Center.
But the court did fiddle with one aspect of their original stance and reinterpreted some of the regulatory wording. While that didn’t change things for the majority, the dissenting judge, Judge N.R. Smith wrote, “despite this significant change in our textual interpretation, the majority remains convinced that our original interpretation of the Parity Act was still correct based on conflicting legislative history and ‘common sense.’ I see it differently and am surprised by the majority’s conclusion.”
Harlick’s attorney Lisa Kantor said the decision was only good news for her client. “This is going to have far reaching implications for anyone who suffers from a severe mental illness,” Kantor said. “Because the decisions clearly states that all medically necessary treatment must be covered for those who suffer from those enumerated mental illnesses.”