An act to amend Section 1374.73 of the Health and Safety Code, and to amend Section 10144.51 of the Insurance Code, relating to health care coverage.
Summary
AB 951 amends California’s health care coverage laws for autism-related behavioral health treatment under both health care service plans regulated by the Department of Managed Health Care and health insurance policies regulated by the Department of Insurance. The bill applies to contracts and policies issued, amended, or renewed on or after January 1, 2026, and prohibits carriers from requiring a person previously diagnosed with pervasive developmental disorder or autism to obtain a new diagnosis in order to keep coverage for behavioral health treatment. It also bars plans and insurers from discontinuing or delaying existing treatment while a rediagnosis is pending.
The bill preserves carrier oversight tools in other ways. A treating provider may still reevaluate a patient to determine appropriate treatment, may prescribe a rediagnosis if clinically appropriate, and must make the treatment plan available to the plan or insurer upon request. The bill also clarifies that utilization review remains allowed and is distinct from rediagnosis, and it leaves intact existing requirements for network adequacy, prior authorization, case management, copayments, and other cost-sharing mechanisms already authorized under current law.
Impact
AB 951 narrows the circumstances under which health plans and health insurers may condition autism behavioral health coverage on a new diagnostic evaluation, thereby strengthening continuity of care for enrollees and insureds with autism or pervasive developmental disorder. It amends Section 1374.73 of the Health and Safety Code and Section 10144.51 of the Insurance Code, affecting both managed care plans and health insurance policies, while leaving existing autism coverage mandates and related education, Medi-Cal, and specialty-policy exclusions in place. The bill also creates a state-mandated local program for purposes of criminal enforcement under the Knox-Keene Act, but states that no reimbursement is required.
Sentiment
The bill appears to have had broadly favorable support throughout the legislative process. It advanced on consent calendars and passed committee and floor votes unanimously or near-unanimously, with no recorded opposition in the provided voting history. The lack of committee transcript material suggests there was little public controversy in the available record, and the final enactment as Chapter 84 indicates the measure was accepted as a targeted consumer-protection and continuity-of-care fix.
Contention
The main policy tension in AB 951 is between preventing unnecessary administrative barriers for families seeking autism treatment and preserving insurer authority to review medical necessity. Supporters would view the bill as stopping redundant rediagnosis requirements that can interrupt care, while carriers may have been concerned about losing a utilization or documentation tool. The bill addresses that concern by expressly allowing reevaluation, utilization review, prior authorization, and treatment-plan requests, while prohibiting only mandatory rediagnosis as a condition of continued coverage. No specific opposition is reflected in the provided votes or transcripts.
An act to amend Sections 1385.01 and 1385.035 of the Health and Safety Code, and to amend Sections 10181 and 10181.35 of the Insurance Code, relating to health care coverage.
An act to amend Sections 1371 and 1371.35 of the Health and Safety Code, and to amend Sections 10123.13 and 10123.147 of the Insurance Code, relating to health care coverage.