AUTISM INSURANCE COVERAGE UPDATE...GREAT NEWS!

NEWS RELEASE


INSURANCE COMMISSIONER DAVE JONES APPLAUDS COURT DECISION ON COVERAGE UNDER CALIFORNIA MENTAL HEALTH PARITY ACT

Decision, in Which Department Submitted Amicus Brief, Reaffirms Health Plans Are Required to Cover

All Medically Necessary Treatment for Severe Mental Illnesses Insurance Commissioner Dave Jones announced today the Ninth Circuit Court of Appeals issued a decision reconfirming its previous holding in Harlick v. Blue Shield that the California Mental Health Parity Act requires health plans to cover all medically necessary treatment for severe mental illnesses, subject only to financial terms and conditions, such as deductibles and copays, applicable to coverage for physical illnesses. The court agreed with arguments Commissioner Jones made in an amicus curiae brief.

“This is a critically important decision that will help end unfair challenges so many families face when seeking autism treatment for their children," Commissioner Jones said. “I applaud the court’s reaffirmation of its prior decision, thus making treatment for autism and other mental illnesses more accessible to the families and children needing it. I also applaud Lisa Kantor and Elizabeth Green, the lead attorneys for Ms. Harlick, for their advocacy and determination in securing this outcome.”

Following issuance of a decision in August 2011, Blue Shield petitioned the panel of three judges to rehear the case or, alternatively, refer it to the full Ninth Circuit for rehearing. Yesterday’s decision makes some modifications to the court’s earlier analysis, but reaffirms its conclusion that Blue Shield must provide coverage.

The plaintiff in the case, Jeanene Harlick was a patient covered under a Blue Shield health plan. She was treated for anorexia at a residential care facility. Although anorexia is categorized as a severe mental illness under the California Mental Health Parity Act, Blue Shield denied coverage. It asserted, among other things, hat residential treatment is not a specifically listed benefit under the Mental Parity Act and therefore not covered. The court rejected Blue Shield’s argument.

The court’s decision declares two important principles protecting patients with mental illness, including autism. First, the Mental Health Parity Act creates a mandate that insurers provide coverage for all medically necessary treatment for severe mental illness, which, like anorexia, may be life threatening. Second, coverage may be limited only by the same financial terms and conditions, such as deductibles or copays, applicable to coverage for physical illnesses.

Please visit the Department of Insurance Web site at www.insurance.ca.gov. Non-media
inquiries should be directed to the Consumer Hotline at 800.927.HELP. Out-of-state callers,
please dial 213.897.8921.

Thanks to the tireless Lou Vismara for spreading the word!
Louis A. Vismara MD 
Policy Consultant to Senator Darrell Steinberg
Office of the President Pro Tempore 
The State Capitol, Rm. 415
Sacramento, CA 95814