Cal. Code Regs. tit. 10 § 2562.4

Current through Register 2024 Notice Reg. No. 21, May 24, 2024

Section 2562.4 - Behavioral Health Treatment for Pervasive Developmental Disorder or Autism

(a) Scope of Section. In addition to the limitations on scope set forth in section 2562.1 of this article, the scope of this section 2562.4 shall be further limited by the following sentence: This section does not apply to a policy or plan described in subdivision (d) of Insurance Code section 10144.51.

(b) In cases where behavioral health treatment is medically necessary, an insurer shall not deny or unreasonably delay coverage for behavioral health treatment:

(1) Based on an asserted need for cognitive, developmental or intelligence quotient (IQ) testing,

(2) On the grounds that behavioral health treatment is experimental, investigational, or educational,

(3) On the grounds that behavioral health treatment is not being, will not be, or was not, provided or supervised by a licensed person, entity or group when the provider or supervisor in question is certified by a national entity, such as the Behavior Analyst Certification Board, that is accredited by the National Commission for Certifying Agencies,

(4) On the grounds that behavioral health treatment has been, is being, should be or will be provided by a Regional Center contracting with the Department of Developmental Services,

(5) On the grounds that an annual visit limit has been reached or exceeded, or

(6) For any other reason, provided, however, that the insurer may apply a deductible or other financial term or limit when the same term or limit is equally applicable to all benefits under the policy.

Cal. Code Regs. Tit. 10, § 2562.4

1. New section filed 3-11-2013 as an emergency; operative 3-11-2013 (Register 2013, No. 11). A Certificate of Compliance must be transmitted to OAL by 9-9-2013 or emergency language will be repealed by operation of law on the following day.
2. New section refiled 9-9-2013 as an emergency; operative 9-9-2013 (Register 2013, No. 37). A Certificate of Compliance must be transmitted to OAL by 12-9-2013 or emergency language will be repealed by operation of law on the following day.
3. New section filed 11-20-2013 as an emergency; operative 12-9-2013 pursuant to Government Code section 11346.1(d) (Register 2013, No. 47). A Certificate of Compliance must be transmitted to OAL by 3-10-2014 or emergency language will be repealed by operation of law on the following day.
4. Certificate of Compliance as to 11-20-2013 order, including amendment of section, transmitted to OAL 3-7-2014 and filed 4-10-2014; amendments effective 4-10-2014 pursuant to Government Code section 11343.4(b)(3) (Register 2014, No. 15).

Note: Authority cited: Sections 790.10, 10144.5, 10144.51, 12921 and 12926, Insurance Code; CalFarm Ins. Co. v. Deukmejian, 48 Ca1.3d 805 (1989); 20th Century Ins. Co. v. Garamendi, 8 Cal.4th 216 (1994). Reference: Sections 790.03, 10144.5(a), 10144.5(c) and 10144.51, Insurance Code.