Health care coverage: behavioral diagnoses.

Plain English Breakdown

The bill does not provide details on enforcement mechanisms or consequences beyond making violations a crime.

Health Care Coverage: Behavioral Diagnoses

AB-951 stops health care plans from requiring people previously diagnosed with autism or pervasive developmental disorder to get a new diagnosis to maintain coverage for behavioral health treatment after January 1, 2026.

What This Bill Does

• Prohibits health insurance and health care service plans from requiring an enrollee or insured person previously diagnosed with autism or pervasive developmental disorder to receive another diagnosis in order to continue receiving behavioral health treatment coverage starting on January 1, 2026.
• Requires these plans to provide a treatment plan upon request.
• Makes willful violation of this provision by a health care service plan a crime.

Who It Names or Affects

• People with autism or pervasive developmental disorder who need behavioral health treatments.
• Health insurance companies and health care service plans in California.

Terms To Know

Pervasive Developmental Disorder

A type of condition that affects how a person communicates, interacts with others, and behaves. Autism is one example of a pervasive developmental disorder.

Health Care Service Plan Act of 1975 (Knox-Keene)

A law in California that sets rules for health care service plans to make sure they are licensed and regulated properly.

Limits and Unknowns

• The bill does not specify what happens if someone with autism or pervasive developmental disorder needs a new diagnosis for reasons other than maintaining coverage.
• It is unclear how the law will be enforced after January 1, 2026.

Official Summary Text

AB 951, Ta.
Health care coverage: behavioral diagnoses.
Existing law, the Knox-Keene Health Care Service Plan Act of 1975, provides for the licensure and regulation of health care service plans by the Department of Managed Health Care, and makes a willful violation of the act a crime. Existing law provides for the regulation of health insurers by the Department of Insurance. Existing law requires a health care service plan contract or health insurance policy to provide coverage for behavioral health treatment for pervasive developmental disorder or autism.
This bill would prohibit a health care service plan contract or health insurance policy issued, amended, or renewed on or after January 1, 2026, from requiring an enrollee or insured previously diagnosed with pervasive developmental disorder or autism to receive a rediagnosis to maintain coverage for behavioral health treatment for their
condition. The bill would require a treatment plan to be made available to the plan or insurer upon request. Because a willful violation of this provision by a health care service plan would be a crime, the bill would impose a state-mandated local program.
The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.
This bill would provide that no reimbursement is required by this act for a specified reason.

Current Bill Text

Download Bill PDF