Signed by Governor Gavin Newsom

Vote Smart's Synopsis:

Vote to amend and pass a bill that prohibits health care plans from requiring re-diagnosis for continued coverage of behavior health conditions, such as autism, in California.

Highlights:

• Prohibits a health care service plan contract issued, amended, or renewed on or after January 1, 2026  to require an enrollee previously diagnosed with a pervasive developmental disorder or autism to receive a rediagnosis to maintain coverage (Sec 1).

• Authorizes a provider to reevaluate  an enrollee for purposes of determining the appropriate treatment (Sec. 1).

• Authorizes a treating provider to prescribe a rediagnosis at the discretion of the licensed physician (Sec. 1).

• Prohibits a health care service plan from discontinuing or delaying existing treatment while waiting for rediagnosis to be completed (Sec. 1).

• Authorizes a health care service plan to require utilization review (Sec. 1).

• Requires the treatment plan to be reviewed no less than once every 6 months by the qualified autism service provider and include (Sec. 1):

• A description of the patient's behavioral health impairments or developmental challenges that are to be treated;

• Design of an intervention plan that includes service type, number of hours, parent participation needed, and the frequency at which progress is evaluated;

• Intervention plans that utilize evidence-based practices, with demonstrated clinical efficacy; and 

• A plan to discontinue intensive behavioral intervention services when treatment goals and objectives are achieved and no longer appropriate.

• Prohibits the treatment plan from being used for purposes of providing or for the reimbursement of respite, daycare, or educational services, or to reimburse a parent for participating in the treatment program (Sec. 1).

Full Bill Text