"Yes" to Autism Therapy, "No" to Budget Reform: Brown

California insurers will have to cover behavioral treatments for autism

By Sharon Bernstein
|  Thursday, Oct 13, 2011  |  Updated 8:34 AM PDT
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Gov. Jerry Brown signed a number of bills over the weekend, including a requirement that insurers cover behavioral therapies for people with autism. He also signed measures aimed at curbing bullying and under-age drinking.

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Health insurers will be required to pay for key behavioral therapies for people with autism and other pervasive developmental disorders under a bill signed over the weekend by Gov. Jerry Brown.

Related: Bills Signed, Vetoed by Governor

The treatments help people with autism spectrum disorders learn a wide range of behaviors that may not come naturally to them: a therapist may help an autistic child to learn to eat with utensils or how to make eye contact. Others work on higher level skills, helping people learn how to endure frustrations without erupting in violent tantrums, or how to sit quietly in school.

Once the bill takes effect in 2012, insurers will no longer be able to claim that the treatment is educational rather than medical, and deny it on that basis, said Jamie Court, president of the advocacy group Consumer Watchdog. Court said that judges in several key cases have already ruled that the treatment should be covered.

"It’s a step forward for the rights of autistic families because it doesn’t leave the insurance companies any outs to deny this as educational rather than medical," Court said.

The bill was one of several signed by the governor over the weekend, tackling such varied issues as school bullying, gun control and under-age drinking.  He vetoed a bill aimed at bringing oversight to the state budget process, saying it was a “one size fits all solution” that would cost millions to implement.

The bullying law, authored by Assembly member Tom Ammiato (D-San Francisco), requires school districts in the state to develop formal policies and procedures for preventing and responding to harassment and bullying. It was one of many measures nationwide spurred by incidents of bullying of gay youngsters that were followed by suicide.

Another bill signed by the governor forbids potential employers from running credit reports on every job applicant. Employers can still check credit if an applicant is applying for a management  job or will have access to certain types of financial information.

The governor also agreed with a proposal to make it illegal to carry an unloaded handgun in public places in the state. The bill exempts law enforcement officials and others who are licensed to carry firearms.

And he signed a measure aimed at curbing teen drinking by forbidding the use of self-serve checkout stands for purchases of alcoholic beverages.

Brown vetoed a bill that would have required intensive oversight of the state budget process. The measure, designed to bring so-called “performance metrics”  to the state, would have required each department to figure out just what the benefits were of all of its expenditures, and prove that the effort was worth the cost.

The measure passed the legislature with unanimous support, but Brown said it would cost tens of millions of dollars to implement without solving the state’s real problems.

The new law requiring coverage for behavioral services for people with autism was roundly criticized by the health insurance industry.

The California Association of Health Plans said it would cost $541 million per year to pay for the services, plus nearly $300 million more for other types of interventions that the industry worries will be required under some interpretations of the bill.

Patrick Johnston, president of the industry organization, said the treatment was educational in nature, not medical.

The law, Johnston said, "would to drive up health care costs for families and businesses .... by transferring responsibility for educational services to health insurers." 

But autism treatment advocate Kristin Jacobson said the industry's cost estimates are exaggerated.  

Although the cost of treatment can be as high as $50,000 if a patients needs intensive intervention, that's less than insurers would pay for surgeries or expensive drugs that they routinely authorize, said Jacobson, spokeswoman for The Alliance of California Autism Organizations.

"There are lots of medical treatments that are expensive," Jacobson said. "But the reason you pay for health insurance is that when you have a condition that strikes, then you can get the treatment for it. And I don’thtink individuals with this condition have any less right to treatment."

Let us know what you think. Comment below, send us your thoughts via Twitter @PropZero or add your comment to our Facebook page.

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