Of Autism - Sedgwick LLP

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Of Autism - Sedgwick LLP

VOLUME XXIX, Issue 2, Spring 2011

A Publication of the California Society for Healthcare Attorneys

Announcements.....................3

New Members...........................3

Articles

Insurance Coverage for Treatment of

Autism: Legal Trends in California and

Nationwide

By Gary S. Pancer and Dina R. Richman

Sedgwick LLP.................................4

California Leads the Way in Health

Insurance Reform

Kevin C. Milne

U.S. Department of Health and

Human Services..............................10

Jerry Brown: No Stranger to Health

Care Issues

Brent Barnhart................................ 18

PPACA Fluency Crossword.............. 24

Acknowledgement of

Editors...................................... 27


Editors

Raja Sekaran

Co-Chair

Catholic Healthcare West

Telephone: (415) 438-5690

Email: raja.sekaran@chw.edu

Steve Phillips

Co-Chair

Hooper, Lundy & Bookman, PC

Telephone: (415) 875-8508

Email: sphillips@health-law.com

Board of Editors

Kate Butler

Palomar Pomerado Health

San Diego

Kathryn Coburn

Health IT Law Group

Pacific Palisades

Christine Covert Cohn

Sheppard Mullin Richter & Hampton LLP

Los Angeles

Benjamin Gluck

Bird, Marella, Boxer, et al.

Los Angeles

Shelley Hubner

Health Net

San Francisco

David Kalifon, M.D., J.D.

David Kalifon Law Corporation

Malibu

Katherine Lauer

Latham & Watkins LLP

Los Angeles

Sam Maizel

Pachulski Stang Ziehl & Jones LLP

Los Angeles

Marty Thompson

Manatt, Phelps & Phillips LLP

Costa Mesa

Karen Weinstein

MemorialCare Health System

Fountain Valley

Staff

Patricia Ward

Program Coordinator

California Society for Healthcare Attorneys

Telephone: (916) 552-7605

Email: pward@calhealth.org

2010–2011 Board of Directors

PRESIDENT

Sarah G. Benator

Arent Fox LLP

Los Angeles

PRESIDENT-ELECT

Art Chenen

Theodora Oringher Miller & Richman

Los Angeles

IMMEDIATE PAST-PRESIDENT

Elspeth Delaney-Paul

Catholic Healthcare West

Pasadena

CHIEF FINANCIAL OFFICER

Raja Sekaran

Catholic Healthcare West

San Francisco

EXECUTIVE DIRECTOR

Lois J. Richardson

California Hospital Association

Sacramento

DIRECTORS AT LARGE

Henry Fenton

Fenton Nelson LLP

Los Angeles

Crystal Lautrup

Prospect Medical/Alta Hospitals System

Los Angeles

Astrid Meghrigian

Attorney at Law

San Francisco

Patrick Moore

Patrick K. Moore Law Corporation

Irvine

Susan Penney

UCSF Medical Center

San Francisco

Steve Phillips

Hooper, Lundy & Bookman, PC

San Francisco

A. Robert Singer

Law Office of A. Robert Singer

Lafayette

Karen Weinstein

MemorialCare Health System

Fountain Valley

2

California Health Law News


Insurance Coverage for Treatment

of Autism: Legal Trends in California and Nationwide

Gary S. Pancer

Sedgwick LLP

Dina R. Richman

Sedgwick LLP

Introduction

The word “autism” comes from the Greek

word, “αυτος,” which means “self.” It was

so named because it is a disorder of neural

development characterized by impaired

social interaction and communication—in

effect, the person is an isolated “self.” Today,

Autism Spectrum Disorders (“ASDs”),

which include Autistic Disorder, Asperger

Syndrome, and Pervasive Developmental

Disorder – Not Otherwise Specified, are

estimated to affect an average of 1 in 110

children in the United States. 1 While there

is no cure for ASDs, effective treatment can

vastly improve an individual’s social and

functional skills and quality of life.

Treatment for ASDs is multi-disciplinary,

and typically involves behavioral,

therapy, special education and speech

and language therapy. Since there is no

cure for autism, management of children

and adults with autism is usually lifelong

and very expensive. One of the

difficulties in implementing effective

coverage for treatment of autism and

other developmental disabilities is that

such treatment and behavior management

encompass more than just pure medical

or mental health care services that would

typically be covered under health insurance

plans. The main goals when treating

children with autism are to lessen associated

deficits and family distress and to increase

quality of life and functional independence.

No single treatment is best, and treatment is

typically tailored to the child’s needs. 2

Although many psychosocial interventions

have some positive evidence, suggesting

that some form of treatment is preferable

to none, the methodological quality of

systematic reviews of these studies has

generally been poor, their clinical results

are mostly tentative, and there is little

evidence for the relative effectiveness of

treatment options. 3 Intensive, sustained

special education programs and behavior

therapy early in life can help children

acquire self-care, social, and job skills 4

and often improve functioning and

decrease symptom severity and maladaptive

behaviors. 5 Available approaches include

applied behavior analysis, developmental

models, structured teaching, speech and

language therapy, social skills therapy and

occupational therapy. 6

In California, there is a complex, multisourced

system of paying for this treatment

which consists of the regional care

system, the school districts and private

health insurance. This article will discuss

California’s framework for coverage of

autism treatments, the recent trends in

autism coverage litigation, and changes

in the statutory, regulatory, and consumer

marketplaces related to insurance coverage

of autism.

The Framework for ASDs

Coverage in California

There are multiple sources of treatment

and funding for the management of ASDs.

In California, there are three primary

resources: health insurance, the regional

center system, and the school districts. What

is covered by each of these sources varies by

age, individual need, and type of treatment.

Although this article is primarily focused

on health insurance, it is useful to provide

background information on the various

systems. Additionally, because the regional

centers and school districts are governmentfinanced,

they have faced steep cuts in

recent years due to staggering budget

shortfalls, and it is anticipated that there

will be additional cuts in future years. In his

inaugural speech, Governor Brown called

for “courage and sacrifice” in addressing

California’s estimated $28 billion budget

deficit in 2011. Significant cuts in the statefunded

programs will undoubtedly lead to

additional claims being brought by families

4

California Health Law News


with autistic children to their private health

insurer or health plan.

Health Insurance

In California, health insurers are regulated

by the Department of Insurance (“DOI”)

and governed by the Insurance Code, and

health care service plans are regulated by

the Department of Managed Health Care

(“DMHC”) and governed by the Health &

Safety Code. For purposes of this article,

however, the terms “health insurer” and

“health plan” may be used interchangeably.

The California Mental Health Parity

Act, Health & Safety Code §1374.72

and Insurance Code §10144.5, requires

health plans to cover the diagnosis and

medically necessary treatment of severe

mental illnesses, under the same terms

and conditions applied to other medical

conditions. Those benefits must include:

(1) Outpatient services; (2) Inpatient

hospital services; (3) Partial hospital

services; and (4) Prescription drugs, if

the plan contract includes coverage for

prescription drugs. “Severe mental illness”

is defined to specifically include “pervasive

developmental disorder or autism.” One

of the implementing regulations, 28 Cal.

Code Regs. §1300.74.72(a), provides that

health plans must cover medically necessary

basic health care services including, at

a minimum, “crisis intervention and

stabilization, psychiatric inpatient

hospital services, including voluntary

psychiatric inpatient services, and services

from licensed mental health providers

including, but not limited to, psychiatrists

and psychologists.” According to 28 Cal.

Code Regs. §1300.74.72(b), the treatment

must be provided by health care providers

acting within the scope of their licensure,

and within their scope of competence,

established by education, training, and

experience.

The Regional Center System 7

In California, the Lanterman

Developmental Disabilities Services Act

(commonly known as the Lanterman Act,

Welfare & Institutions Code §4400 et seq.)

established an entitlement to services and

supports for persons of all ages with a

developmental disability and gave the State

a responsibility to provide services and

supports. The State does so through the

regional center system. A regional center is

a community-based non-profit corporation

chartered in state law and operating under

contract with the state Department of

Developmental Services (“DDS”). There

are 21 regional centers in California, each

serving a designated geographic area. The

regional center system serves over 240,000

children and adults with developmental

disabilities. The Lanterman Act assigns

to regional centers the responsibility for

providing a range of direct services and

supports to clients and their families.

These include assessment and evaluation

to determine eligibility for regional center

services; development of an Individual

Program Plan (“IPP”); coordination of

services and supports to help clients and

their families achieve the desired outcomes

specified in their IPP; assistance in finding

and using community and other resources;

support and facilitation of the inclusion

and integration of children and adults

with developmental disabilities with their

non-disabled peers; outreach activities to

identify persons who may need regional

center services; development of innovative

and cost-effective services and supports that

are flexible, individualized and promote

community integration; assurance of

the quality and effectiveness of services

and supports provided to clients and

their families; advocacy to protect the

legal, civil and service rights of people

with developmental disabilities; and

information, referral to other resources and

individual and family support. Importantly,

regional center services available under the

Lanterman Act are only available after all

private insurance or other generic sources

are exhausted or do not cover the services at

issue. 8

Generally, IPPs are developed for every

individual three years of age or older who

receives services from a regional center. An

initial IPP is completed within 60 days of

the person being determined eligible for

regional center services. If one or more

of the desired outcomes in a person’s IPP

cannot be achieved using personal resources

(such as family and friends), natural

supports or generic services (such as health

insurance), the regional center can purchase

the necessary services.

Infants and toddlers may also be eligible

for early intervention services if they

have a developmental delay in cognitive,

communication, social or emotional,

adaptive, or physical and motor

development including vision and hearing

and are under 24 months of age at the

time of referral, with a 33% delay in one

or more areas of development or are 24

months of age or older at the time of

referral, with a 50% delay in one area of

development or a 33% delay in two or more

areas of development; or have an established

risk condition of known etiology, with a

high probability of resulting in delayed

development. Early intervention services

may include assistive technology, audiology,

family training, counseling, home visits,

health services, medical services for

diagnostic/evaluation purposes, nursing

services, nutrition services, occupational

therapy, physical therapy, psychological

services, respite services, service

coordination, social work services, special

instruction, speech and language services,

transportation, and vision services. 9

California Health Law News 5


The overall state DDS budget for funding

the regional centers is approximately $4

billion. The Governor’s current budget

proposal calls for a $750 million General

Fund reduction to the regional centers

effective in July 2011. This is on top of

the $334 million General Fund reductions

from the 2009–2010 budget. With these

large cuts to the regional center system,

and future cuts likely, other sources for

coverage of autism treatment will become

increasingly important.

The Public School System

For individuals ages three through 21,

the public school system provides many

services for autism and other disabilities.

The federal mandate for this comes from

the Individuals with Disabilities Education

Act (“IDEA”) (20 U.S.C. §1400 et seq.).

“Disability” is specifically defined to include

autism. 10 IDEA has been reauthorized and

amended a number of times, most recently

in December 2004. Its terms are further

defined by regulations of the United

States Department of Education, which

are found in Parts 300 and 301 of Title

34 of the Code of Federal Regulations.

The 2004 amendments clarify Congress’

intended outcome for each child with a

disability: students must be provided a Free

Appropriate Public Education (“FAPE”)

that prepares them for further education,

employment and independent living.

The IDEA requires that public schools

create an Individualized Education Program

(“IEP”) for each eligible student. The IEP

specifies the services that are to be provided

and how often, describes the student’s

present level of performance, and what

accommodations and/or modifications

must be provided to the student. The IEP

can include “related services,” such as

transportation and such developmental,

corrective, and other supportive services

as are required to assist a child with a

disability to benefit from special education,

such as speech-language pathology and

audiology services; psychological services;

physical and occupational therapy; music

therapy; recreation, including therapeutic

recreation; early identification and

assessment of disabilities in children;

counseling services, including rehabilitation

counseling; orientation and mobility

services; and medical services for diagnostic

or evaluation purposes. It also includes

school health services, social work services

in schools, and parent counseling and

training. 11

Litigation Trends In

Coverage of Autism

Treatment

In the 1990s and earlier, litigation over

autism coverage involved the issue of

whether autism was a covered medical

condition at all. 12 This seems to be in the

past, and it is now widely accepted (and

mandated in most states) that autism is

a covered disorder in health insurance

policies. Instead, the litigation has shifted

to disputes over what kinds of treatment

are covered. The most litigated of these

treatments is Applied Behavior Analysis

(“ABA,” also called Applied Behavioral

Analysis). ABA includes “the design,

implementation, and evaluation of

environmental modifications to produce

socially significant improvements in human

behavior, through skill acquisition and the

reduction of undesirable behaviors.” 13 Many

health plans have denied ABA on a number

of bases, ranging from medical necessity, to

experimental and licensure exclusions.

One of the first lawsuits involving ABA was

Wheeler v. Aetna Life Insurance Company, 14

a 2003 Illinois case in which the health

insurer had denied coverage for ABA,

occupational therapy, and speech therapy

for an autistic child. Coverage was denied

on the basis that there was a “developmental

delay” exclusion and the treatment was

not medically necessary. The health insurer

moved for summary judgment, arguing

that there was no coverage. In denying the

motion, the court noted that,

Aetna failed to acknowledge

the actual language of the

plan provisions and failed to

analyze [the child’s problems]

in accordance with those plan

provisions. Aetna did not and does

not explain why it rejected the

opinions of [the child’s] medical

providers. Aetna chose not to

conduct an independent medical

examination. Because Aetna failed

to make a rational connection

between the evidence, the plan

language, and its conclusion to

terminate speech therapy benefits,

its termination of benefits was

arbitrary and capricious.

Several years later, in Mayfield v. ASC

Incorporated Health and Welfare Benefits

Plan, 15 a district court in Illinois overturned

a health plan’s denial of ABA, finding

that ABA is neither investigative nor

experimental for treatment of autism.

After the Mayfield case, the same plaintiff ’s

attorney brought a class action in

Michigan, Johns v. Blue Cross Blue Shield

of Michigan, 16 alleging that Blue Cross

Blue Shield categorically denied ABA for

treatment of autism on the basis that it

is “experimental.” During the course of

the lawsuit, the court ordered Blue Cross

Blue Shield to produce certain documents,

which effectively repudiated the claim that

ABA was experimental. Apparently, a 2005

medical policy statement from Blue Cross

Blue Shield stated, “[ABA] is currently

the most thoroughly researched treatment

modality for early intervention approaches

to autism spectrum disorders and is the

standard of care recommended by the

American Academy of Pediatrics, National

6

California Health Law News


Academy of Science Committee and the

Association for Science in Autism treatment,

among others.” Shortly after the production

of this document, the case settled. As part

of the settlement, Blue Cross Blue Shield

agreed to reimburse all families who paid

for ABA for their children after May 1,

2003 and who were covered under a Blue

Cross Blue Shield of Michigan policy.

Not all litigation over ABA has been

successful, however. In Graddy v. Blue

Cross Blue Shield of Tennessee 17 (in which

plaintiff alleged that ABA had been

categorically denied as experimental),

for instance, the district court denied

plaintiff’s motion for class certification

because individual issues would dominate

over common class issues. In McHenry v.

Pacific Source Health Plans, 18 an Oregon

court found that ABA cannot be excluded

as “experimental” or “educational,” but

that the particular treatment at issue could

not be covered because the provider was not

eligible for reimbursement under Oregon

law.

In California, recent litigation has focused

on whether ABA provided by non-licensed

providers must be covered by insurers. The

first case, Arce v. Kaiser Foundation Health

Plan, 19 resulted in a published appellate

opinion and has now been remanded to the

trial court. In Arce, the plaintiff, on behalf

of a putative class, alleged that Kaiser had

a pattern and practice of denying ABA on

the basis that it consists of “non-health

care services,” “academic or educational

interventions,” or “custodial care.” Kaiser

succeeded on demurrer by arguing that

the court should abstain from making

individual medical necessity determinations.

On appeal, the Court of Appeal reversed

this judgment. In doing so, it noted that

the issue of whether ABA provided by

non-licensed providers is included in the

Mental Health Parity Act is a question of

statutory interpretation, not individual

determinations of medical necessity,

and therefore the plaintiff could state a

claim on this basis. Notably, the Court of

Appeal did not actually resolve the issue of

whether non-licensed ABA treatment must

be covered, and instead remanded it to the

trial court. Currently, the Arce case remains

in the trial court, and at the time of this

writing, a class certification motion has not

been filed, and the case has not been set for

trial.

In another case, Consumer Watchdog v.

California Department of Managed Health

Care, 20 Consumer Watchdog, a consumer

advocacy organization, alleges that the

California Department of Managed Health

Care (“DMHC”) is allowing health plans

to deny coverage for ABA because it is not

provided by a licensed professional. The

lawsuit seeks an injunction requiring the

DMHC to require health plans to cover

medically necessary ABA. When the lawsuit

was filed, the DMHC released a statement

which said,

We have not yet fully analyzed the

lawsuit, however, the DMHC is

holding health plans accountable

to provide a range of health care

services for those with autism. We

have explicitly told health plans

that they may not exclude any

particular therapies or treatments

for Autism Spectrum Disorder that

have been determined to be health

care services and are administering

the consumer complaint process

according to law. 21

Thereafter, the DMHC demurred to

Consumer Watchdog’s petition, but it

was overruled by the court, which stated

that, “plans must offer [ABA services by

non-licensed professionals] unless they

have licensed providers who will provide

the same services.” 22 However, the hearing

on the merits of Consumer Watchdog’s

petition was on December 13, 2010, and

the presiding judge was not the same one

who ruled on the demurrer. On December

30, 2010, the court issued its decision,

refusing to order the DHMC to require

health plans to cover ABA provided by

unlicensed practitioners. In doing so, the

court noted, “What’s wrong with requiring

licensing Why delegate quality control

to a private entity especially in dealing

with health care and in particular autistic

young people … There is no ministerial

duty to do so.” 23 The court then instructed

that Consumer Watchdog’s remedy must be

with the legislature, not with the courts.

A press release from Consumer Watchdog

said it is considering its legal options to

address this ruling. It has also released

statements encouraging Governor Brown’s

new administration to change the policy on

coverage of ABA from unlicensed providers.

At the time of this writing, Consumer

Watchdog had filed a motion for a new trial.

Another issue in the Consumer Watchdog

case was whether the DMHC had exceeded

its authority by issuing a memorandum

regarding appeal procedures for denials

of autism treatment. The memo had, in

part, stated that for any appeal to the

DMHC after a denial of autism coverage,

the DMHC would initially make a

determination whether the service being

sought is a covered health service, and then,

if it is found to be covered, refer it to an

independent medical review (“IMR”) for a

determination on whether the treatment is

medically necessary and/or experimental. 24

The court found that this provision

constituted a “regulation” because there was

more than one plausible interpretation of

the underlying statute, and that the DMHC

had exceeded its authority by issuing this

memo outside of the rulemaking process

set forth in the Administrative Procedures

Act. Nonetheless, the court still found

that nothing prohibits the DMHC from

California Health Law News 7


determining coverage prior to referring the

appeal to an IMR.

The opposite issue is at play in California

Association of Health Plans v. Lucinda

Ehnes, Director, Department of Managed

Health Care et al. 25 In this case, the

California Association of Health Plans

(“CAHP”) brought an action for

declaratory relief against the DMHC

alleging that the DMHC has exceeded

its statutory authority by expanding the

definition of “basic health care services”

to include all “services provided by licensed

providers acting within the scope of their

licensure” and requiring health plans

to cover all such services. Although the

complaint does not specifically mention

ABA or autism, that treatment is clearly

implicated by the suit. Indeed, the DMHC

(unsuccessfully) attempted to consolidate

the Consumer Watchdog case with this one.

In essence, the CAHP suit is the opposite of

the Consumer Watchdog suit because while

the CAHP suit alleges that the DMHC has

exceeded its authority by requiring plans

to cover too much, the Consumer Watchdog

suit alleges that the DMHC has exceeded

its authority by allowing plans to cover too

little. Because this lawsuit was only filed in

October of 2010, it is still in its beginning

stages and it is too early to predict its

outcome.

Statutory, Regulatory, and

Marketplace Changes to

Coverage

While litigation is one way that coverage

for autism treatment has evolved, state

legislatures and regulators have also

taken up the issue. At least 23 states—

Arizona, Colorado, Connecticut,

Florida, Illinois, Indiana, Iowa, Kansas,

Kentucky, Louisiana, Maine, Massachusetts,

Missouri, Montana, Nevada, New

Hampshire, New Jersey, New Mexico,

Pennsylvania, South Carolina, Texas,

Vermont and Wisconsin—specifically

require insurers to provide coverage for

the treatment of autism. 26 Many other

states, including California (as discussed

above), require coverage for autism as

part of broader mental health laws.

California has also set up a Legislative Blue

Ribbon Commission on Autism to provide

recommendations on improving treatment

and diagnosis of autism and closing gaps in

services and programs.

At least two bills have recently been

introduced in the California legislature

that, if passed, would increase insurance

coverage of autism treatment. AB 171,

introduced in the California Assembly by

Assembly Member Beall, would (1) require

health plans to cover screening, diagnosis,

and treatment of ASDs; (2) require health

plans to develop and maintain networks of

qualified autism service providers; and (3)

prohibit health plans from denying essential

treatments to individuals with ASDs

and related disorders. Similarly, SB 166,

introduced by Senator Steinberg, states that

it is the intent of the legislature to enact

legislation that would develop standards

for the diagnosis and treatment by health

care service plans and health insurers of

individuals with ASDs.

Regulatory actions have also buoyed autism

coverage. The DMHC, as discussed above,

is embroiled in various lawsuits over autism

coverage. In March 2009, however, it issued

a memorandum entitled, “Improving Plan

Performance to Address Autism Spectrum

Disorders.” 27 This memo instructed that

health plans must cover all medically

necessary basic health care services required

under the Knox-Keene Act for persons

with autism through licensed or certified

providers, and may not categorically exclude

any particular health care treatment or

therapy for autism. Similarly, the results of

IMRs, which are available on the DMHC

website, show that in 11 of the 14 IMRs

involving ABA treatment for autism in

2009 and 2010, the denial of coverage was

overturned. 28

In some cases, the marketplace itself has

induced insurers to provide coverage

for autism treatment. For instance, as a

result of Johns v. Blue Cross Blue Shield

of Michigan, Blue Cross Blue Shield of

Michigan started offering treatment

coverage for autistic children, ages two to

five, whose families are insured under their

employers’ group policies that offer mental

health coverage.

Conclusion

The one pattern emerging from these

various lawsuits, regulatory actions, and

marketplace changes is that coverage

disputes for treatment of autism are

increasing. All the stakeholders in the

autism coverage debate will benefit from

having clearer legislative guidance related to

autism coverage issues. Until then, case law

will continue to develop in this area. Health

plans and health insurers will need to keep

current on the various court challenges

and legislative changes to ensure that their

policies and coverage decisions comply with

the emerging autism coverage requirements.

8

California Health Law News


About the Authors

Gary Pancer is a partner with Sedgwick LLP

and a member of the firm’s Health Care

Practice in Los Angeles. Mr. Pancer has

extensive experience representing healthcare

service plans, physicians and other healthcare

clients in litigation and risk management.

He also represents healthcare clients in

administrative proceedings before numerous

state and federal agencies including the

Department of Managed Health Care, the

Medical and Dental Boards of California and

the U.S. Department of Labor. Mr. Pancer can

be reached at gary.pancer@sedgwicklaw.com.

Dina R. Richman is an associate at the

Los Angeles office of Sedgwick LLP and a

member of the firm’s Healthcare Practice

Group. Ms. Richman primarily represents

health plans, managed care organizations,

insurance companies, provider groups,

third party administrators, and healthcare

professionals in state and federal litigation.

She may be reached at

dina.richman@sedgwicklaw.com.

Endnotes

1 Centers for Disease Control and Prevention,

http://www.cdc.gov/ncbddd/autism/data.html.

2 Myers SM, Johnson CP, Council on Children with

Disabilities. “Management of children with autism

spectrum disorders.” Pediatrics. 2007;120(5):1162–

82.

3 Krebs Seida J, Ospina MB, Karkhaneh M,

Hartling L, Smith V, Clark B. “Systematic Reviews of

Psychosocial Interventions for Autism: an Umbrella

Review.” Dev Med Child Neurol. 2009;51(2):95–104.

4 Myers SM, Johnson CP, Council on Children with

Disabilities. “Management of Children with Autism

Spectrum Disorders.” Pediatrics. 2007;120(5):1162–

82.

5 Rogers SJ, Vismara LA. “Evidence-Based

Comprehensive Treatments for Early Autism.” J Clin

Child Adolesc Psychol. 2008;37(1):8–38.

6 Myers SM, Johnson CP, Council on Children with

Disabilities. “Management of children with autism

spectrum disorders.” Pediatrics. 2007;120(5):1162–

82.

7 Disclaimer: the authors of this article are both

affiliated with Frank D. Lanterman Regional Center.

Gary Pancer is the Immediate Past President of the

Board of Directors, and Dina Richman is currently a

member of the Board of Directors.

8 Cal. Welf. & Inst. Code §4659(a).

9 Cal. Govt. Code §95014(a).

10 20 U.S.C. §1401(3)(A).

11 20 U.S.C. §1401(26)(A).

12 See, e.g., Kunin v. Benefit Trust Life Insurance

Company (9th Cir. 1990) 910 F.2d 534.

13 17 CCR §54342(8).

14 (N.D. Ill. 2003) 2003 WL 21789029.

15 (E.D. Mich. 2007) 2007 WL 5272861, Case No.

06-15105.

16 (E.D. Mich.) Case No. 2:08-cv-12272.

17 (E.D. Tenn.) 2010 WL 670081, Case No. 4:09-

cv-84.

18 (D. Or. 2010) 679 F.Supp.2d 1226.

19 (2010) 181 Cal.App.4th 471.

20 Los Angeles Superior Court Case No. BS121397,

filed June 30, 2009.

21 DMHC Press Release, June 30, 2009.

22 Order on Demurrer, October 20, 2009,

available at www.consumerwatchdog.org/resources/

AutismOrderOnDemurrer.pdf.

23 Decision re: Petition for Writ of Mandate,

December 30, 2010.

24 March 9, 2009 Memorandum from the DMHC

re “Improving Plan Performance to Address Autism

Spectrum Disorders.”

25 Sacramento Superior Court Case No. 34-2010-

00090594, filed October 29, 2010.

26 For a list of the applicable statutes, see the

National Conference of State Legislatures, “Insurance

Coverage for Autism,” available at

http://www.ncsl.org/tabid=18246.

27 March 29, 2009 Memorandum from Department

of Managed Health Care to Licensed Full Service

Health Plans and Specialized Mental Health Care

Service Plans.

28 http://wp.dmhc.ca.gov/imr/search.asp.

California Health Law News 9


A c k n o w l e d g e m e n t s

California Health Law News wishes to thank the

following Publications Committee Members for

their editorial work on the articles included in

this issue:

Insurance Coverage for Treatment of Autism:

Legal Trends in California and Nationwide

By Gary S. Pancer and Dina R. Richman

Sedgwick LLP

Edited by Kate Butler

California Leads the Way in Health Insurance

Reform

By Kevin C. Milne

U.S. Department of Health & Human Services

Edited by Steve Phillips

Jerry Brown: No Stranger to Health Care

Issues

By Brent Barnhart

Edited by Lois Richardson

PPACA Fluency Crossword

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