Autism Treatment Claims Dispute Can Go To Trial

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LOS ANGELES, CA — A lawsuit seeking health care coverage for the use of applied behavioral analysis in the treatment of autism has been cleared for trial by the Los Angeles County Superior Court.

Consumer Watchdog et. al. vs. California Department of Managed Health Care et. al. involves Kaiser Permanente’s denial of coverage for a child’s ABA treatment because the provider wasn’t licensed by the state. The Oakland, Calif.-based health maintenance organization cited regulations issued by the California Department of Managed Health Care as its reason for denying coverage for ABA treatment.

However, the lawsuit, filed by Consumer Watchdog, a Santa Monica, Calif.-based consumer advocacy organization, asserted that the state’s Mental Health Parity Act requires health care insurers to provide for the diagnosis and medically necessary treatment of severe mental illness and serious emotional disturbances of a child “under the same terms and conditions applied to other medical conditions.” The statute also expressly lists autism as a severe mental illness.

Because the State Department of Managed Health Care does not impose a similar licensure requirement on providers treating other medical conditions, the court concluded that the regulation could not be applied to treatment of autism.

“A refusal to pay for… services based on the fact that the provider is not licensed is inconsistent with the intent of parity,” Los Angeles Superior Court Judge James C. Chalfant wrote in his Oct. 20 ruling.

The case now goes to trial in the court, where a Nov. 5 hearing date has been set.

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