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Health Plan Exclusion Involving Autism Violated MHPAEA

March 10, 2021 10:52 AM | OEHA (Administrator)

In a coverage dispute over autism treatment, the District Court for the Northern District of California held that a health plan's autism-related exclusion for Applied Behavioral Analysis (ABA) therapy violated the Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA). The court also concluded that the plan's third-party administrator (TPA) was an ERISA fiduciary regarding its denial of benefits under the plan's exclusion.

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