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Study cites wider access to autism services in California but higher co-pays

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A study released Tuesday by the Autism Society of California evaluates the efficacy of access to autism services, such as behavioral therapies, in California since the passing of SB 946.

The original bill mandated that insurance companies cover Applied Behavior Analysis (ABA) therapy as a medical treatment for those diagnosed on the autism spectrum. The bill was signed in 2011, went into effect in 2012 and was renewed in 2013.

The survey found overall wider access to to these services through the insurance mandate. The number of families accessing behavioral health treatments through regional centers increased from 51% to 62%, with an increase to 88% for children under five years of age. Families not accessing services through regional centers increased from 30% to 38%.

The largest shift in funding was from regional center funded to insurance funded services, which increased from 9% to 38% as of February 2014, decreasing regional center funding from 39% to 24%. Overall, insurance funding regional center and non-regional center families emphatically increased by 240% and 400% respectively.

Strangely, the survey indicates that 14% were still denied behavioral treatments, 44% due to "advanced age," even though the law has no age caps, 33% due to low cognitive function, 22% due to high cognitive function, 22% cited location of service, none of which are reasons for denial under the law.

The most alarming finding, however, was that 39% of denials classified behavioral treatments as experimental, a false assertion and decidedly not an appropriate reason for denial.

While families can more readily access services under this law, the survey also cited much higher costs from co-pays reported as a result of shifting payment responsibility from state-funded regional centers to families.

An addition to the bill renewal last year shifted cost responsibility from regional centers to families. This was intended to save the state money, but instead may end up costing the state more because regional centers are responsible for children transferring from private insurance to Medi-Cal.

Some of the data from the survey may be limited by the number of respondents and language of the survey, representing only about 1.9% of the projected autism population of California.

While SB 946 is clearly working to allow wider access to behavioral services for families of children on the autism spectrum, those same families are citing dissatisfaction due to those high co-pays and deductibles. A reevaluation of the bill's contents this year could ameliorate this dissatisfaction with an otherwise effective and vital law.

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