Autistic adults are routinely told that behavioral health treatment is a children's benefit. Read the statute and the striking thing is what is not in it.

The short answer: California's autism mandate contains no age limit. Health & Safety Code §1374.73 says "[e]very health care service plan contract that provides hospital, medical, or surgical coverage shall also provide coverage for behavioral health treatment for pervasive developmental disorder or autism no later than July 1, 2012. The coverage shall be provided in the same manner and is subject to the same requirements as provided in Section 1374.72," and the section nowhere uses an age, a maximum age, or the words "child," "minor" or "adult."¹ The insurance-side twin, Insurance Code §10144.51, is the same.² Neither has a sunset; the repeal clause — originally a 2014 date, extended to 2017 — was deleted in 2016.¹ And for any contract "issued, amended, or renewed on or after January 1, 2026," a plan "shall not require an enrollee previously diagnosed with pervasive developmental disorder or autism to receive a rediagnosis to maintain coverage" — which closes the commonest way adults were refused.¹ Separately, the parity statute requires plans to apply "the criteria and guidelines set forth in the most recent versions of treatment criteria developed by the nonprofit professional association for the relevant clinical specialty," expressly "in children, adolescents, and adults."³ Medi-Cal is the exception that runs the other way: its behavioral health treatment benefit is defined by statute as a service "for individuals under 21 years of age."⁴

What the mandate says, and what it leaves out

The operative sentence is short: "Every health care service plan contract that provides hospital, medical, or surgical coverage shall also provide coverage for behavioral health treatment for pervasive developmental disorder or autism no later than July 1, 2012."¹

Behavioral health treatment is defined in the section itself as "professional services and treatment programs, including applied behavior analysis and evidence-based behavior intervention programs, that develop or restore, to the maximum extent practicable, the functioning of an individual with pervasive developmental disorder or autism" and that meet four criteria.¹ In outline: the treatment is prescribed by a licensed physician and surgeon or developed by a licensed psychologist; it is delivered under a treatment plan prescribed by a qualified autism service provider and administered by that provider, a supervised qualified autism service professional, or a supervised paraprofessional; the plan "has measurable goals over a specific timeline that is developed and approved by the qualified autism service provider for the specific patient being treated"; and it is not used for "respite, daycare, or educational services" or to pay a parent for taking part.¹

Now the absence. We asked the statute directly whether it uses an age, an age cap, or the words "under the age of," "years of age," "child," "minor" or "adult" anywhere in its text. It does not.¹ The duty attaches to every qualifying plan contract, subject only to the two carve-outs in subdivision (e) — specialised plans that do not deliver mental or behavioral health services, and Medi-Cal contracts.¹ There is no age at which it switches off.

That silence is the point of this page. An adult refused ABA is usually being refused on a plan's own utilisation criteria or on a medical-necessity judgment — not because the mandate stopped applying on a birthday.

The 2026 change that matters most to adults

Both mandates were amended by SB 402, effective 1 January 2026. The amendment most worth knowing says: "A health care service plan contract issued, amended, or renewed on or after January 1, 2026, shall not require an enrollee previously diagnosed with pervasive developmental disorder or autism to receive a rediagnosis to maintain coverage for behavioral health treatment for pervasive developmental disorder or autism."¹

Think about who that protects. An adult diagnosed at seven, or at thirty, who is told by a plan to produce a fresh diagnostic evaluation before anything is authorised — and who then discovers that adult autism assessments are expensive, scarce, and waitlisted. Rediagnosis is defined twice over in the section: as "[a] subsequent undertaking by any method, device, or procedure, whether gratuitous or not, to ascertain or establish if a person is suffering from a physical or mental health disorder, pursuant to Section 2038 of the Business and Professions Code," and also as "prescription of a subsequent diagnosis of pervasive developmental disorders or autism to ascertain or establish if a person is suffering from a pervasive developmental disorder or autism."¹

The section preserves other things alongside it: a treating provider may still reevaluate, a physician or psychologist may still prescribe a rediagnosis in their discretion, and ordinary utilisation review is unaffected.¹ And it protects treatment already running: "A health care service plan shall not discontinue or delay existing treatment while waiting for a rediagnosis to be completed."¹

Who counts as a qualified provider

SB 402 also moved the provider definitions out of the insurance code and into the Business and Professions Code. A "qualified autism service provider" is now "an individual described in Section 4999.200 of the Business and Professions Code."¹

That section describes two routes. One: a person who "[i]s certified by a national entity, such as the Behavior Analyst Certification Board, with a certification that is accredited by the National Commission for Certifying Agencies who designs, supervises, or provides treatment for pervasive developmental disorder or autism, provided the services are within the experience and competence of the individual who is nationally certified."⁵ Two: a person who "[i]s licensed as a physician and surgeon, physical therapist, occupational therapist, psychologist, marriage and family therapist, educational psychologist, clinical social worker, professional clinical counselor, speech-language pathologist, or audiologist," who designs, supervises or provides such treatment "within the experience and competence of the licensee."⁵

Note the drafting: the statute never says "board certified behavior analyst." It says certified by a national entity "such as" the BACB. A plan that refuses a provider solely because their credential is not BCBA is reading a word into the statute that is not there.

Parity, which reaches adults in as many words

The autism mandate does not stand alone. Since 2021 every qualifying plan contract "shall provide coverage for medically necessary treatment of mental health and substance use disorders, under the same terms and conditions applied to other medical conditions as specified in subdivision (c)."⁶ The covered category is defined by cross-reference: "a mental health condition or substance use disorder that falls under any of the diagnostic categories listed in the mental and behavioral disorders chapter of the most recent edition of the International Classification of Diseases or that is listed in the most recent version of the Diagnostic and Statistical Manual of Mental Disorders."⁶ The statute names no conditions itself; it points at the manuals.

What the parity law then does is take the plan's judgment away from the plan. A plan "shall base any medical necessity determination or the utilization review criteria that the plan, and any entity acting on the plan's behalf, applies … on current generally accepted standards of mental health and substance use disorder care."³ And, critically: "In conducting utilization review of all covered health care services and benefits for the diagnosis, prevention, and treatment of mental health and substance use disorders in children, adolescents, and adults, a health care service plan shall apply the criteria and guidelines set forth in the most recent versions of treatment criteria developed by the nonprofit professional association for the relevant clinical specialty."³ The insurance-side twin says the same.⁷

There is a bridge between the two statutes that is easy to miss. Parity's own definition of the governing clinical standard names behavioral health treatment as one of the relevant specialties: "'Generally accepted standards of mental health and substance use disorder care' means standards of care and clinical practice that are generally recognized by health care providers practicing in relevant clinical specialties such as psychiatry, psychology, clinical sociology, addiction medicine and counseling, and behavioral health treatment pursuant to Section 1374.73."³

So an adult arguing for ABA is not making a novel argument. They are asking the plan to do what the parity statute already tells it to do, using criteria from the field's own professional association, in a review the statute says must be conducted the same way "in children, adolescents, and adults."

What the plan may still do

Quite a lot, and the page would be dishonest not to say so. The mandate expressly preserves management: "in the provision of benefits required by this section, a health care service plan may utilize case management, network providers, utilization review techniques, prior authorization, copayments, or other cost sharing."¹

The treatment plan is visible to the plan: it "shall be made available to the health care service plan upon request."¹ And there is a review cadence in the statute — but read it carefully, because it is a floor on the clinician, not a ceiling on the insurer: the plan "shall be reviewed no less than once every six months by the qualified autism service provider and modified whenever appropriate, and shall be consistent with Section 4686.2 of the Welfare and Institutions Code."¹ The six-month figure has been in the section since it was enacted in 2011, and it has never been a limit on the health plan's own review; the current section sets none. The cross-reference pulls in the regional-centre statute on applied behaviour analysis — a statute drafted around minors, though it too sets no age limit on who may receive the treatment.¹⁰

The mandate is also limited by the federal essential-health-benefits floor: "…as of the date that the proposed final rulemaking for essential health benefits is issued, this section does not require any benefits to be provided that exceed the essential health benefits that all health plans will be required by federal regulations to provide…"¹

The regional centre route, and the trap in it

If you have a developmental disability that originated before 18, a regional centre is the other door. The Lanterman Act defines developmental disability as "a disability that originates before an individual attains 18 years of age, continues, or can be expected to continue, indefinitely, and constitutes a substantial disability for that individual."⁸

But regional centres are the payer of last resort, and the rule has teeth: "regional centers shall not purchase any service that would otherwise be available from Medi-Cal, Medicare, the Civilian Health and Medical Program for Uniform Services, In-Home Support Services, California Children's Services, private insurance, or a health care service plan when a consumer or a family meets the criteria of this coverage but chooses not to pursue that coverage."⁹ And for anyone three or older, a regional centre "shall not purchase medical or dental services … unless the regional center is provided with documentation of a Medi-Cal, private insurance, or a health care service plan denial and the regional center determines that an appeal by the consumer or family of the denial does not have merit."⁹

Which sounds like a wall until you read the next sentence, which is the useful one: regional centres "may pay for medical or dental services during the following periods: (A) While coverage is being pursued, but before a denial is made. (B) Pending a final administrative decision on the administrative appeal if the family has provided to the regional center a verification that an administrative appeal is being pursued. (C) Until the commencement of services by Medi-Cal, private insurance, or a health care service plan."⁹ And: "When necessary, the consumer or family may receive assistance from the regional center, the Clients' Rights Advocate funded by the department, or the state council in pursuing these appeals."⁹

So the sequence is: claim on the insurance, and if it is denied, appeal — while asking the regional centre to fund the gap. The statute contemplates exactly that gap.

There is also a cost-sharing provision with a specifically adult limb. Where a service for "a consumer 18 years of age or older" under their individual program plan is paid for in whole or in part by their own plan or policy, the regional centre "may, when necessary to ensure that the consumer receives the service or support, pay any applicable copayment, coinsurance, or deductible associated with the service or support for which the consumer is responsible if both of the following conditions are met": that the consumer "has an annual gross income that does not exceed 400 percent of the federal poverty level," and that "[t]here is no other third party having liability for the cost of the service or support."¹⁰ For an adult consumer the income test is the consumer's own, not a parent's. Ask the regional centre, and ask in writing.

Medi-Cal is different, and the difference is on the face of the statute

Here the age limit is real and written down: "Only to the extent required by the federal government and effective no sooner than required by the federal government, behavioral health treatment (BHT) shall be a covered Medi-Cal service for individuals under 21 years of age."⁴ The Department of Health Care Services says the same on its own page: "Medi-Cal covers all medically necessary behavioral health treatment (BHT) services for eligible Medi-Cal members under 21 years of age."⁴

We looked for a DHCS sentence affirmatively excluding adults and did not find one. The limitation is expressed positively — the benefit is defined as a service for people under 21 — rather than as an exclusion. That is a meaningful distinction if you are appealing, and it is the honest way to state it.

One boundary to keep straight: the commercial-plan analysis above does not carry into Medi-Cal. Medi-Cal contracts are expressly exempted from the parity criteria statute and from the autism mandate.¹ ³ Does Medi-Cal cover therapy? →

A worked example

You are 34, diagnosed autistic at nine, on a commercial HMO through work. Your psychiatrist recommends behavioral health treatment and the plan denies it, saying BHT is a paediatric benefit and asking for a current diagnostic evaluation.

Two things are wrong with that letter, and both are quotable back at them. The mandate names no age.¹ And if your contract was issued, amended or renewed on or after 1 January 2026, the plan "shall not require an enrollee previously diagnosed with … autism to receive a rediagnosis to maintain coverage."¹

You file the plan's internal grievance. The plan upholds the denial. Now the Independent Medical Review clock starts: you may apply to the Department of Managed Health Care "within six months of any of the qualifying periods or events" — and "[t]he director may extend the application deadline beyond six months if the circumstances of a case warrant the extension"¹¹ — and the qualifying event here is that "[t]he enrollee has filed a grievance with the plan or its contracting provider pursuant to Section 1368, and the disputed decision is upheld or the grievance remains unresolved after 30 days." The same paragraph adds that "[t]he enrollee shall not be required to participate in the plan's grievance process for more than 30 days," three days where the grievance requires expedited review.¹¹ It costs nothing: "The enrollee shall pay no application or processing fees of any kind."¹¹

In the IMR you are not arguing about your age. You are arguing that the plan failed to apply "the criteria and guidelines … developed by the nonprofit professional association for the relevant clinical specialty," which the statute requires "in children, adolescents, and adults."³ Independent Medical Review → · How to file a DMHC complaint →

Q&A

Q: Does the mandate expire? A: No. The current section contains no sunset, repeal, or "shall remain in effect only until" language. It used to: as enacted in 2011 the section was to become inoperative in 2014; that was extended, so the 2015 version carried "This section shall remain in effect only until January 1, 2017, and as of that date is repealed"; and the 2016 version has no such language, credited to Stats. 2016, Ch. 493.¹

Q: My policy is regulated by the insurance department, not DMHC. Does this apply? A: Yes, in the same terms. "Every health insurance policy shall also provide coverage for behavioral health treatment for pervasive developmental disorder or autism no later than July 1, 2012. The coverage shall be provided in the same manner and is subject to the same requirements as provided in Section 10144.5."² That section names no age limit and has no sunset either.²

Q: Is autism a "mental health condition" for parity? A: The parity statutes do not name it. They define the covered category by cross-reference to the diagnostic manuals.⁶ Whether a given condition is listed in those manuals is a fact about the manuals, not something California law says, and this page will not put a claim about the DSM into the statute's mouth.

Q: Can the plan make me be re-evaluated by its own provider? A: It can conduct utilisation review, which the section preserves and distinguishes from rediagnosis.¹ What it cannot do, for a contract issued, amended or renewed on or after 1 January 2026, is require a rediagnosis as a condition of maintaining coverage for someone already diagnosed.¹

Q: I was diagnosed as an adult, after 18. Does the regional centre route still work? A: The Lanterman Act's definition requires a disability that "originates before an individual attains 18 years of age."⁸ Originating before 18 is not the same as being diagnosed before 18, and regional centres assess that question themselves. Ask; do not assume either way.

Q: What if my treatment is already running and the plan wants a rediagnosis? A: Subdivision (c)(4): "A health care service plan shall not discontinue or delay existing treatment while waiting for a rediagnosis to be completed."¹ Quote it to the plan in writing.

Work, and what you can ask for: Workplace accommodations for mental health →

If the plan is self-funded through your employer: The self-funded plan problem →

Our therapist directory: See its current status →

In crisis? Call or text 988 — free, 24/7.

Sources

  1. Cal. Health & Safety Code §1374.73 — (a)(1) "Every health care service plan contract that provides hospital, medical, or surgical coverage shall also provide coverage for behavioral health treatment for pervasive developmental disorder or autism no later than July 1, 2012. The coverage shall be provided in the same manner and is subject to the same requirements as provided in Section 1374.72."; (a)(2) "Notwithstanding paragraph (1), as of the date that the proposed final rulemaking for essential health benefits is issued, this section does not require any benefits to be provided that exceed the essential health benefits that all health plans will be required by federal regulations to provide under Section 1302(b) of the federal Patient Protection and Affordable Care Act (Public Law 111-148), as amended by the federal Health Care and Education Reconciliation Act of 2010 (Public Law 111-152)."; (a)(3) "This section does not affect services for which an individual is eligible pursuant to Division 4.5 (commencing with Section 4500) of the Welfare and Institutions Code or Title 14 (commencing with Section 95000) of the Government Code."; (b) the network-adequacy duty; (c)(1) "A health care service plan contract issued, amended, or renewed on or after January 1, 2026, shall not require an enrollee previously diagnosed with pervasive developmental disorder or autism to receive a rediagnosis to maintain coverage for behavioral health treatment for pervasive developmental disorder or autism."; (c)(4) "A health care service plan shall not discontinue or delay existing treatment while waiting for a rediagnosis to be completed."; (d)(1) "'Behavioral health treatment' means professional services and treatment programs, including applied behavior analysis and evidence-based behavior intervention programs, that develop or restore, to the maximum extent practicable, the functioning of an individual with pervasive developmental disorder or autism and that meet all of the following criteria:", with (d)(1)(C) "The treatment plan has measurable goals over a specific timeline that is developed and approved by the qualified autism service provider for the specific patient being treated. The treatment plan shall be reviewed no less than once every six months by the qualified autism service provider and modified whenever appropriate, and shall be consistent with Section 4686.2 of the Welfare and Institutions Code…" and (d)(1)(D) "The treatment plan is not used for purposes of providing or for the reimbursement of respite, daycare, or educational services and is not used to reimburse a parent for participating in the treatment program. The treatment plan shall be made available to the health care service plan upon request."; (d)(2) "'Qualified autism service provider' means an individual described in Section 4999.200 of the Business and Professions Code."; (d)(5) "'Rediagnosis' means a subsequent undertaking by any method, device, or procedure, whether gratuitous or not, to ascertain or establish if a person is suffering from a physical or mental health disorder, pursuant to Section 2038 of the Business and Professions Code. 'Rediagnosis' also means prescription of a subsequent diagnosis of pervasive developmental disorders or autism to ascertain or establish if a person is suffering from a pervasive developmental disorder or autism."; (e) the section does not apply to "(1) A specialized health care service plan that does not deliver mental health or behavioral health services to enrollees" or "(2) A health care service plan contract in the Medi-Cal program"; (g) "As provided in Section 1374.72 and in paragraph (1) of subdivision (a), in the provision of benefits required by this section, a health care service plan may utilize case management, network providers, utilization review techniques, prior authorization, copayments, or other cost sharing." — california.public.law, read 14 September 2026. A targeted check of the section for an age, an age cap, or the words "under the age of," "years of age," "child," "minor" or "adult" returned none. Subdivisions (c)(2), (c)(3), (c)(5) and (f) are described rather than quoted on this page. The current text is credited to Stats. 2025, Ch. 413, Sec. 5.5 (SB 402), effective 1 January 2026 — law.justia.com. On the sunset: as chaptered in 2011 (SB 946) the section was to become inoperative on 1 July 2014; Stats. 2013, Ch. 680 extended that, so the 2015 code text carried subdivision (g), "This section shall remain in effect only until January 1, 2017, and as of that date is repealed, unless a later enacted statute, that is enacted before January 1, 2017, deletes or extends that date" — law.justia.com — and the 2016 text carries no such language, credited "Amended by Stats. 2016, Ch. 493, Sec. 1. Effective January 1, 2017." — law.justia.com. Which bill deleted it is an inference from that before-and-after comparison and the chapter number; we did not read the bill text.
  2. Cal. Insurance Code §10144.51(a)(1) — "Every health insurance policy shall also provide coverage for behavioral health treatment for pervasive developmental disorder or autism no later than July 1, 2012. The coverage shall be provided in the same manner and is subject to the same requirements as provided in Section 10144.5." — california.public.law. A targeted check returned no age restriction and no sunset in the section. Current text credited to Stats. 2025, Ch. 413, Sec. 8.5 (SB 402), effective 1 January 2026 — law.justia.com.
  3. Cal. Health & Safety Code §1374.721 — (a) "A health care service plan that provides hospital, medical, or surgical coverage shall base any medical necessity determination or the utilization review criteria that the plan, and any entity acting on the plan's behalf, applies to determine the medical necessity of health care services and benefits for the diagnosis, prevention, and treatment of mental health and substance use disorders on current generally accepted standards of mental health and substance use disorder care."; (b) "In conducting utilization review of all covered health care services and benefits for the diagnosis, prevention, and treatment of mental health and substance use disorders in children, adolescents, and adults, a health care service plan shall apply the criteria and guidelines set forth in the most recent versions of treatment criteria developed by the nonprofit professional association for the relevant clinical specialty."; (f)(1) "'Generally accepted standards of mental health and substance use disorder care' means standards of care and clinical practice that are generally recognized by health care providers practicing in relevant clinical specialties such as psychiatry, psychology, clinical sociology, addiction medicine and counseling, and behavioral health treatment pursuant to Section 1374.73. Valid, evidence-based sources establishing generally accepted standards of mental health and substance use disorder care include peer-reviewed scientific studies and medical literature, clinical practice guidelines and recommendations of nonprofit health care provider professional associations, specialty societies and federal government agencies, and drug labeling approved by the United States Food and Drug Administration."; subdivision (k) exempts Medi-Cal contracts — california.public.law. Credited "Added by Stats. 2020, Ch. 151, Sec. 5. (SB 855) Effective January 1, 2021."
  4. Cal. Welfare & Institutions Code §14132.56(a)(1) — "Only to the extent required by the federal government and effective no sooner than required by the federal government, behavioral health treatment (BHT) shall be a covered Medi-Cal service for individuals under 21 years of age." — california.public.law. California Department of Health Care Services, Behavioral Health Treatment — "Medi-Cal covers all medically necessary behavioral health treatment (BHT) services for eligible Medi-Cal members under 21 years of age" — dhcs.ca.gov, read 14 September 2026; the page does not address coverage for members 21 and over. The Medi-Cal provider manual carries the same sentence — mcweb.apps.prd.cammis.medi-cal.ca.gov. We searched for, and did not find, a DHCS statement affirmatively excluding members 21 and over; the limitation is expressed positively rather than as an exclusion.
  5. Cal. Business & Professions Code §4999.200 — (a) "Is certified by a national entity, such as the Behavior Analyst Certification Board, with a certification that is accredited by the National Commission for Certifying Agencies who designs, supervises, or provides treatment for pervasive developmental disorder or autism, provided the services are within the experience and competence of the individual who is nationally certified."; (b) "Is licensed as a physician and surgeon, physical therapist, occupational therapist, psychologist, marriage and family therapist, educational psychologist, clinical social worker, professional clinical counselor, speech-language pathologist, or audiologist, pursuant to Division 2 (commencing with Section 500), and who designs, supervises, or provides treatment for pervasive developmental disorder or autism, provided the services are within the experience and competence of the licensee." — california.public.law. The professional and paraprofessional criteria at B&P §§4999.201 and 4999.202 were not retrieved at verification and are not described here.
  6. Cal. Health & Safety Code §1374.72 — (a)(1) "Every health care service plan contract issued, amended, or renewed on or after January 1, 2021, that provides hospital, medical, or surgical coverage shall provide coverage for medically necessary treatment of mental health and substance use disorders, under the same terms and conditions applied to other medical conditions as specified in subdivision (c)."; (a)(2) defining "mental health and substance use disorders" as "a mental health condition or substance use disorder that falls under any of the diagnostic categories listed in the mental and behavioral disorders chapter of the most recent edition of the International Classification of Diseases or that is listed in the most recent version of the Diagnostic and Statistical Manual of Mental Disorders" — california.public.law. The Insurance Code twin, §10144.5(a)(1), is word-for-word identical except for "disability insurance policy," and its (a)(2) uses the long manual names — california.public.law.
  7. Cal. Insurance Code §10144.52(b) — "In conducting utilization review of all covered health care services and benefits for the diagnosis, prevention, and treatment of mental health and substance use disorders in children, adolescents, and adults, a disability insurer shall apply the criteria and guidelines set forth in the most recent versions of the treatment criteria developed by the nonprofit professional association for the relevant clinical specialty." — california.public.law.
  8. Cal. Welfare & Institutions Code §4512(a)(1) — developmental disability defined as "a disability that originates before an individual attains 18 years of age, continues, or can be expected to continue, indefinitely, and constitutes a substantial disability for that individual."; (b) "'Services and supports for persons with developmental disabilities' means specialized services and supports or special adaptations of generic services and supports directed toward the alleviation of a developmental disability or toward the social, personal, physical, or economic habilitation or rehabilitation of an individual with a developmental disability, or toward the achievement and maintenance of an independent, productive, and normal life." — california.public.law. The section's list of included conditions was obtained in summary and is not quoted here.
  9. Cal. Welfare & Institutions Code §4659 — (a) "the regional center shall identify and pursue all possible sources of funding for consumers receiving regional center services," including "(2) Private entities, to the maximum extent they are liable for the cost of services, aid, insurance, or medical assistance to the consumer."; (c) "Effective July 1, 2009, notwithstanding any other law or regulation, regional centers shall not purchase any service that would otherwise be available from Medi-Cal, Medicare, the Civilian Health and Medical Program for Uniform Services, In-Home Support Services, California Children's Services, private insurance, or a health care service plan when a consumer or a family meets the criteria of this coverage but chooses not to pursue that coverage."; (d)(1) "Effective July 1, 2009, notwithstanding any other law or regulation, a regional center shall not purchase medical or dental services for a consumer three years of age or older unless the regional center is provided with documentation of a Medi-Cal, private insurance, or a health care service plan denial and the regional center determines that an appeal by the consumer or family of the denial does not have merit," and "Regional centers may pay for medical or dental services during the following periods: (A) While coverage is being pursued, but before a denial is made. (B) Pending a final administrative decision on the administrative appeal if the family has provided to the regional center a verification that an administrative appeal is being pursued. (C) Until the commencement of services by Medi-Cal, private insurance, or a health care service plan."; (d)(2) "When necessary, the consumer or family may receive assistance from the regional center, the Clients' Rights Advocate funded by the department, or the state council in pursuing these appeals."; (e) "This section shall not impose any additional liability on the parents of children with developmental disabilities, or to restrict eligibility for, or deny services to, any individual who qualifies for regional center services but is unable to pay." — california.public.law. A targeted check confirmed the section contains no sentence mentioning copayment, coinsurance or deductible; that authority is in §4659.1.
  10. Cal. Welfare & Institutions Code §4659.1(b) — "If a service or support provided to a consumer 18 years of age or older, pursuant to the consumer's individual program plan, is paid for in whole or in part by the consumer's health care service plan or health insurance policy, the regional center may, when necessary to ensure that the consumer receives the service or support, pay any applicable copayment, coinsurance, or deductible associated with the service or support for which the consumer is responsible if both of the following conditions are met: (1) The consumer has an annual gross income that does not exceed 400 percent of the federal poverty level. (2) There is no other third party having liability for the cost of the service or support, as provided in subdivision (a) of Section 4659 and Article 2.6 (commencing with Section 4659.10)." — california.public.law. Applied behaviour analysis purchased through regional centres is governed by §4686.2, whose subdivision (a) opens "Notwithstanding any other law or regulation to the contrary, any vendor who provides applied behavioral analysis (ABA) services, or intensive behavioral intervention services or both, as defined in subdivision (d), shall:" — california.public.law; the regional-centre duties in subdivision (b)(1) were returned truncated at verification and are not quoted here, save that (b)(1)(F) speaks of "a minor consumer" — the section is drafted around children but imposes no age limit on who may receive the treatment.
  11. Cal. Health & Safety Code §1374.30 — (k) "An enrollee may apply to the department for an independent medical review of a decision to deny, modify, or delay health care services, based in whole or in part on a finding that the disputed health care services are not medically necessary, within six months of any of the qualifying periods or events under subdivision (j). The director may extend the application deadline beyond six months if the circumstances of a case warrant the extension."; (j)(3) "The enrollee has filed a grievance with the plan or its contracting provider pursuant to Section 1368, and the disputed decision is upheld or the grievance remains unresolved after 30 days. The enrollee shall not be required to participate in the plan's grievance process for more than 30 days. In the case of a grievance that requires expedited review pursuant to Section 1368.01, the enrollee shall not be required to participate in the plan's grievance process for more than three days."; (l) "The enrollee shall pay no application or processing fees of any kind." — california.public.law.

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