Mental Health & Autism Health Project Web Resources

"Allowed Amount" or “Usual and Customary” information

The Fair Health Medical Cost Lookup offers information on estimated costs for healthcare professionals’ services.

California AB 796

Requires health insurance providers to provide coverage for behavioral health, including autism spectrum disorders.

Federal Mental Health Parity & Addiction Equity Act (MHPAEA)

MHPAEA requires that the financial requirements (such as coinsurance) and treatment limitations (such as visit limits) imposed on mental health and substance use disorder benefits cannot be more restrictive than the predominant financial requirements and treatment limitations that apply to substantially all medical/surgical benefits.

FAQ on Federal Mental Health Parity I

Knox Keene Act

This CA act requires that the services provided by health care service plans be available to enrollees at reasonable times and makes a violation of its provisions a crime.

California Mental Health Parity Law (AB88)

California Code of Regulations, Health Care Service Plans

U.S. Department of Labor Whistle Blowers Program

Allows you to file complaints against employer-funded ERISA health plans.

CDI Emergency Regulation Timely Access to Care

2015 Plans must make arrangements to provide out-of-network care at in network prices when there are insufficient in-network care providers

CDI Emergency Regulation Access to Autism Benefits

2013 Plans may not deny ABA therapy based on it being "experimental." They may not require cognitive testing, and they may not require a state licensure if the provider is a BCBA.

ACA Regulations

stating insurers must continue to provide existing coverage of treatment until an appeal is resolved.

Section 147.136 F (2) (iii) Requirement to provide continued coverage pending the outcome of an appeal. A plan and issuer subject to the requirements of this paragraph (b)(2) are required to provide continued coverage pending the outcome of an appeal. For this purpose, the plan and issuer must comply with the requirements of 29 CFR 2560.503-1(f)(2)(ii), which generally provides that benefits for an ongoing course of treatment cannot be reduced or terminated without providing advance notice and an opportunity for advance review.

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