Health care coverage: behavioral diagnoses.

Assemblymember Ta's legislation prohibits health insurers and care plans from requiring rediagnosis of autism or pervasive developmental disorders to maintain behavioral health treatment coverage, starting January 2026. The measure allows providers to continue evaluating patients for appropriate treatment while preventing coverage disruptions during assessment periods.

The bill maintains insurers' ability to conduct utilization reviews of existing treatments while distinguishing these from rediagnosis requirements. Treatment plans must remain available to insurers upon request, and providers retain discretion to prescribe rediagnosis when medically indicated.

Health plans and insurers must continue maintaining networks of qualified autism service providers who supervise professionals and paraprofessionals delivering behavioral health treatments. The legislation preserves existing requirements for treatment plans to include measurable goals, regular provider reviews, and evidence-based intervention strategies.

The provisions apply to health insurance policies and managed care plans, excluding specialized plans without mental health coverage and Medi-Cal contracts. The measure designates willful violations by health plans as criminal offenses while specifying that implementation creates no additional costs requiring state reimbursement to local agencies.