Regulators Target Insurers for Not Covering Autism Therapy

Jessica Vernabe California insurance regulators are cracking down on Blue Shield of California and other insurers to provide a certain type of autism therapy. Blue Shield denied covering certain behavior-related autism services on the grounds that they aren’t “medically necessary.” Regulators argue that medical research supports the therapy as beneficial to those suffering with the condition. The California Department of Insurance has filed a cease and desist order on July 13 against the Sacramento-based insurer for refusing to cover Applied Behavior Analysis (ABA) therapy to two autistic children, the department said. The department is accusing the insurer of violating the California Mental Health Parity Act, which calls for equal coverage for selected mental health conditions and physical conditions. The order follows a settlement agreement the insurer signed on July 11 with the California Department of Managed Health Care to cover the therapy for its members. The said insurer made the decision despite conflicts with its policies—the company doesn’t offer coverage for services that are provided by unlicensed professionals, which is generally the case with ABA. The California Department of Managed Health Care is also in the process of formalizing a similar agreement with Anthem Blue Cross and is in talks with Kaiser Permanente, said Lynne Randolph, the department’s spokeswoman. In a prepared statement, Blue Shield said: “ABA is an intimate, sensitive service sometimes delivered in the home. If a provider is not licensed, there is no governmental authority confirming that the provider is reputable and qualified.” As a result, the agreement includes a requirement that the ABA services covered by Blue Shield be delivered under the supervision of a licensed medical professional, Blue Shield said. In the statement, the insurer said it is “perplexed” by the Department of Insurance’s decision to issue the order since it has already agreed to pay for the ABA therapy in the two listed cases and in all similar cases until legal issues are resolved in court. “We signed an agreement to that effect with the Department of Managed Care and are prepared to do the same with the Department of Insurance,” Blue Shield said. The California Department of Insurance aims to make sure insurance companies are in full compliance with the California mental health parity law. “CDI is taking this action to address the barriers faced by families attempting to obtain behavior therapy and increase their access to proven transformative therapies,” said Adam Cole, general counsel for the department. Hospitalist Company Enters New Market IPC The Hospitalist Company Inc. has made an acquisition in Orlando, Fla., which represents its entry into the metropolitan market, the North Hollywood-based company announced. Through the deal, the local hospitalist physician group company acquired Coast to Coast Physicians Alliance, P.A. IPC expects about 26,000 patient visits annually as a result of the acquisition. Jeffrey Taylor, IPC’s chief operating officer, said the company welcomes Coast to Coast, which has built strong relationships with the Orlando health care community. “We already have a strong presence in many parts of Florida and now see an opportunity to leverage our strengths and infrastructure into the large and growing Orlando market,” Taylor said. Dr. Jauvid Ayadi, co-founder and partner of Coast to Coast will continue with IPC as practice group leader. Coast to Coast partners Prakash Kalan, Robert Powers and Matthew Owens will also remain with the practice. In an unrelated transaction, IPC also acquired the post-acute practice of Dr. Eladio Dieguez, which is based in Ocala, Florida. Drug Treatment Clinic Expands Total Family Support Clinic has moved to a larger facility in Sylmar in order to provide more services and programs to its growing client base, clinic officials said. The non-profit agency, which provides outpatient drug treatment and social services, celebrated the opening of its new site on July 9. Sherman Dale, the clinic’s program director, said the new facility provides ground-level access. “It allows us to bring in clientele that previously we weren’t able to (serve), such as people with disabilities,” he said. The new facility is located at 13788 Foothill Blvd., Unit 6. Previously, the clinic was located at 13714 Foothill Blvd., Suite 240. The clinic opened in 2002 as the first outpatient substance abuse treatment facility to serve co-occurring disorders and youth in the area. Since then, Total Family Support Clinic has also opened facilities downtown Los Angeles and Long Beach, as well as multiple satellite offices. Some of the social services the clinic provides include family counseling, parenting classes, youth drug treatment programs, food distribution programs, anger management and domestic violence programs. Staff Reporter Jessica Vernabe can be reached at (818) 316-3123 or at [email protected]