Health Insurance Coverage of Behavioral Health Treatment for Persons with Autism


To: Family Members of Persons with Autism or Pervasive Developmental Disorder

From: Lisa Kleinbub, Director, Health and Behavioral Services

RE: Senate Bill 946 and Private Health Insurance Coverage of Behavioral Health Treatment for Persons with Autism or Pervasive Developmental Disorder.

California Senate Bill 946 authored by Senator Steinberg and supported by many parent advocates was signed into law by the Governor on October 9, 2011. This bill requires private health insurance regulated by the State of California to provide coverage for behavioral health treatment for persons with pervasive developmental disorder or autism. It goes into effect on July 1, 2012. Healthy Families and CalPERS will be required to fund these services due to the state mental health parity law even though the bill excluded these plans. Medi-Cal remains excluded. Some employers who self-fund their health insurance are regulated only by the federal government and this law does not apply to them.

You are receiving this letter because your family member receives behavioral health treatment funded by Regional Center of the East Bay ( RCEB) and has a diagnosis of pervasive developmental disorder or autism. If your family member has private health insurance, CalPERS or Healthy Families, you will need to contact your health insurance to initiate the process of obtaining behavioral health treatment. Private health insurance is considered a generic resource that must be used for available services. You can request assistance with this process from your family member’s pediatrician, other medical providers, and from the insurance plan’s Member Services /Customer Services Department. Your health insurance plan should be able to provide you with a list of their contracted behavioral health providers. You may also want to ask your current behavioral provider if they are contracted with your health insurance for these services.

We are committed to making sure that this is a smooth transition for families and that there are no delays or gaps in this important service so we are asking you to contact your health insurance now. If you receive information from your health insurance that they are not governed by this law, it should only be because your plan is not state regulated. If that is the case, we are asking for information in writing from your employer’s Human Resource Department documenting this fact. Please contact your case manager with any questions or concerns you have about this transition.

We appreciate your efforts in working with your health insurance provider and RCEB during this transition.