Health care coverage: behavioral diagnoses.

Assembly Member Ta proposes changes to California health insurance law that would prevent insurers from requiring individuals previously diagnosed with autism or pervasive developmental disorders to undergo rediagnosis to maintain their behavioral health treatment coverage. The legislation, which would take effect January 1, 2026, applies to both health care service plans and insurance policies.

Under the proposed changes, while treating providers retain the ability to reevaluate patients to determine appropriate treatment, insurers cannot mandate rediagnosis as a condition for continuing coverage. The bill requires insurers to maintain existing treatments during any provider-initiated reevaluation process. Treatment plans must be made available to insurers upon request, and insurers may still conduct utilization reviews to evaluate ongoing care needs.

The legislation maintains existing requirements for behavioral health treatment, including that services be provided under treatment plans developed by qualified autism service providers and delivered by licensed professionals or supervised paraprofessionals. Health plans and insurers must continue maintaining adequate networks of qualified providers while retaining their ability to contract selectively within these parameters.

These provisions exempt specialized health plans that do not offer mental health services and Medi-Cal program policies. The bill preserves all current obligations regarding educational services and other existing treatment requirements under state and federal law.