California Court of Appeal

Denial of plaintiff's writ of mandate seeking to direct defendant to respond to any HMO plan member's grievance challenging a denial of coverage for Applied Behavioral Analysis (ABA) therapy, an intensive form of therapy which has been documented to be successful in treating the symptoms of autism in young children, to be provided or supervised by a Behavior Analyst Certification Board (BACB)-certified therapist, by ordering the plan to cover such therapy, is: 1) reversed in part, where under a recently enacted statute, BACB-certification has implicitly been recognized as an exception to the licensing laws and, therefore, defendant can no longer uphold a plan's denial of coverage for ABA on the basis that a BACB-certified provider is not licensed, but this applies only from the effective date of the statute; but 2) otherwise affirmed.

Appellate Information

• Decided 09/10/2013
• Published 09/10/2013

Judges

• CROSKEY

Court

• California Court of Appeal

Counsel