The California Mental Health Parity Act requires health plans to cover autism spectrum disorders to the same extent that they cover other physical illnesses. We are currently litigating cases for families against health plans and health insurance companies that have denied coverage for autism treatments including Applied Behavioral Analysis (ABA), speech therapy and occupational therapy.

Treatments such as ABA, speech therapy and occupational therapy are covered under the California Mental Health Party Act. The Court explained in one of our current cases, Arce v. Kaiser, that the Mental Health Parity Act, codified at section 1374.72 of the Health and Safety Code, provides that “[e]very health care service plan contract … that provides hospital, medical, or surgical coverage shall provide coverage for the diagnosis and medically necessary treatment of severe mental illnesses of a person of any age … under the same terms and conditions applied to other medical conditions ….” “In essence, section 1374.72 is a mental health insurance mandate which ‘obligate[s] health plans to provide coverage (not merely offer it) for the diagnosis and treatment of mental illness equal to coverage that the plans appl[y] to other medical conditions.’” Arce v. Kaiser (2010) 181 Cal. App. 4th 471, 491. The benefits mandated by the statute include outpatient services, inpatient services and partial hospital services. The terms and conditions that shall be applied equally to all such benefits include, but are not limited to, maximum lifetime benefits, copayments, and deductibles. The statute specifically defines “severe mental illnesses” to include autism.

As explained by the Court of Appeal in Arce, a health care service plan governed by the Knox–Keene Act must provide plan members with “basic health care services.” And the Knox–Keene Act defines “basic health care services” as including “ambulatory or outpatient care,” which are defined to include therapy services such as speech therapy, occupational therapy and behavioral therapy, Arce, 181 Cal. App. 4th at 492 (citing Cal.Code Regs., tit. 28, § 1300.67, subd. (c)).

If your health insurance company or health plan has refused to provide your child with ABA, speech therapy and/or occupational therapy, please contact us.