Behavioral health treatment plans

The law protects access to already authorized behavioral health treatment for people with autism or pervasive developmental disorder. Plans and insurers must keep approved hours available across the authorization period when their use follows the documented treatment plan and clinical guidelines.

What the law does ​

• Bars health plans and insurers from imposing weekly caps or other limits that cause authorized treatment hours to be lost during a six-month authorization period.
• Requires authorized hours to remain available throughout that period when use is reasonably consistent with the treatment plan and clinical guidelines and documented in treatment plans and progress reports.
• Retains insurers’ and health plans’ ability to use utilization review, prior authorization, case management, provider networks, copayments, and other cost sharing.

Who it affects ​

• Enrollees and insured people receiving covered behavioral health treatment for autism or pervasive developmental disorder.
• Health care service plans and health insurers that provide this coverage.
• Qualified autism service providers, professionals, and paraprofessionals administering treatment.

Context ​

The rule does not apply to Medi-Cal plan contracts or policies, or to specified specialized coverage that does not provide mental or behavioral health services.