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Autism Guide

Autism – Essential Benefits & Health Insurance

General Miscellaneous information on Autism 

 

#Applied Behavior Analysis Treatment

  • Applied Behavior Analysis ABA Autism Speaks Website
  • ABA has to do with understanding behavior and how it is affected by the environment. “behavior” refers to actions and skills.   “Environment” includes any influence – physical or social – that might change or be changed by one’s behavior.
  • VIDEO Introduction to  (ABA)  Applied Behavior Analysis treatment
  • Aetna’s Applied Behavior Analysis Medical Necessity Assessment Guide
  • LEGISLATIVE COUNSEL’S DIGEST
    • Existing law …Knox-Keene Health Care Service Plan Act of 1975 (Knox-Keene Act), requires a health care service plan contract or a health insurance policy to provide coverage for behavioral health treatment for pervasive developmental disorder or autism, and defines “behavioral health treatment” to mean specified services provided by, among others, a qualified autism service professional supervised and employed by a qualified autism service provider. Under existing law, to the extent required by the federal government and effective no sooner than required by the federal government, behavioral health treatment, as defined under the Knox-Keene Act, is a covered service under the Medi-Cal program for individuals under 21 years of age, as specified.
    • The bill would require a qualified autism service professional and a qualified autism service paraprofessional to be employed by a qualified autism service provider or an entity or group that employs qualified autism service providers.
    • The bill additionally would authorize a qualified autism service professional, as specified, to supervise a qualified autism service paraprofessional.
    • The bill would revise the definition of a qualified autism service professional to, among other things, specify that the behavioral health treatment provided by the qualified autism service professional may include clinical case management and case supervision under the direction and supervision of a qualified autism service provider.
    • The bill would revise the definition of behavioral health treatment for purposes of the Medi-Cal program to be those services administered by the State Department of Health Care Services as described in the state plan approved by the Centers for Medicare and Medicaid Services.   leginfo.ca.gov *
  • Court Ruling in favor of autism –  AB 1704

#My Medi-Cal 
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FAQ’s

  • Question My son’s father’s employer is refusing to drop our son from his health insurance they are saying we need a court order to take him OFF the insurance. Even though he is fully covered for state funded medi-cal as he is an SSI recipient.
    • My son has autism and his father’s insurance is denying recommended hours of treatment.
  • Answer
    • See the General Information on Autism at the left and/or above.

    • Your husband employer, probably thinks they would be BUSTED if they are thought to be gaining advantage by taking the “sick” people off their group plan!

    • RELEVANT LAW:

      • The following federal laws focus on addressing discrimination based on health status that occurs at the point of enrollment, but only tackle risk management techniques linked to coverage to a limited degree.

         Title VII of the 1964 Civil Rights Act prohibits intentional and disparate impact discrimination in the form of lesser benefits based on race; and prohibits both greater charges and provision of lesser-value benefits based on sex.

        ***I’m not sure of your ethnic background and it’s not relevant to me… BUT my local congresswoman is of what appears to be the same background and 1/2 of her posts are how the US Government discriminates against that ethic background! By the way, she’s IMHO an Idiot on Health Care as she keeps telling the people who elected her in Southern CA to go to Health Care dot gov rather than Covered CA or better yet to the local agents, many of whom I’m sure are of the same ethnic background. Please excuse my rant. Don’t forget President Trump said health care was more complex than anyone knew. He should have asked me or visited this website.

        Americans with Disabilities Act (ADA) and Section 504 of the Rehabilitation Act of 1973 prevent any employer-sponsored plan or public insurance program operating in either the group or individual market from refusing to enroll a qualified person with a disability.

        Thus, if an employer health plan takes off a disabled person, it will “look like” it was the employers idea, not yours.

  • What makes you think Medi Cal will pay for these services and employer group won’t?
    • Medi Cal in CA is all HMO!
    • Also, Social Services are for those in dire need, not ones who have income and employer benefits.
    • I suggest you research the clinical bulletins and try IMR.
  • Question  We’re a provider for ABA Applied Behavior Analysis services only (not a medical facility).
    • A client has Medi-Cal as their secondary insurance and would like us to bill Medi-Cal; however, we are not contracted with Medi-Cal as of yet (we our contracted with Molina). So I have a couple of questions:
      • 1. Can I still bill Medi-Cal for services already rendered?
        2. Can the parent submit receipts to Medi-Cal for paid services on their own behalf for reimbursement?
        3. Is there a phone number of someone I can contact directly to help with questions such as these?
  • Answer – scroll down for our Medi Cal Contact Information

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