Family Rights for ABA Services: Timeline Expectations and Waiting List Protections

Key Legal Rights for ABA Services

California Senate Bill 946 (2012) - Insurance Coverage

ABA Coverage Requirements: All California state-regulated insurance plans must cover Applied Behavior Analysis therapy without annual or lifetime caps. This includes individual plans, fully insured large group plans, and fully insured small group plans.

Network Adequacy: Insurance companies must maintain an adequate network of ABA providers so children with autism have access to necessary care. If no in-network provider is available within required timeframes, insurance must cover out-of-network services at no additional cost to families.

California Senate Bill 221 (2022) - Timely Access

Mental Health Appointment Timelines: Health plans must provide follow-up mental health appointments, including ABA therapy, within 10 business days unless the treating provider determines a longer wait would not be detrimental.

Enforcement: If unable to provide an in-network appointment within 10 business days, insurers must arrange coverage outside their contracted network.

Expected Service Timelines

Insurance-Based ABA Services

Assessment Approval: Insurance typically approves ABA assessments within 5-7 business days after receiving complete documentation

Treatment Authorization: Pre-authorization for ongoing ABA therapy can take anywhere from a few days to several weeks depending on the complexity of the case and completeness of submitted documentation

Provider Assignment: If your insurance cannot find an in-network provider with openings within 10 days, California law requires they find an out-of-network appointment and pay for it

Regional Center Services (Lanterman Act)

Eligibility Timeline: Regional Centers have 120 days maximum after initial intake to decide eligibility, or 60 days if delay would risk health/safety or further developmental delays

Urgent Cases: The 60-day timeline applies when there’s risk of placement in a more restrictive setting or immediate health/safety concerns

Service Implementation: Once eligible, an Individual Program Plan (IPP) meeting must occur within 60 days, and services cannot be delayed by waiting lists

Early Intervention Services (Birth to 3)

Early Start Services: Under California’s Early Intervention Services Act, services must begin “as soon as possible” after the Individualized Family Service Plan (IFSP) is developed

No Waiting Lists: Federal and state law prohibits waiting lists for early intervention services

Waiting List Rights and Protections

Services That CANNOT Have Waiting Lists

Regional Center Services: Regional Centers are legally prohibited from placing children on waiting lists for services. They must contract with available providers or request exceptions from the Department of Developmental Services to purchase services from other providers.

Early Intervention Services: Children birth to 3 years cannot be placed on waiting lists for Early Start services. Regional Centers and school districts must employ staff or contract for services to ensure required services are provided.

Special Education Services: Under federal IDEA requirements, IEP services must be implemented “as soon as possible” following the IEP meeting with no undue delay.

What to Do If Placed on a Waiting List

Regional Center Services:

• File a complaint with the Department of Developmental Services

• Request a fair hearing through the Regional Center appeals process

• Contact Disability Rights California for advocacy support

Insurance Services:

• Request a case manager from your insurance’s behavioral health department

• File a complaint with the Department of Managed Health Care (888-466-2219) or California Department of Insurance (800-927-4357)

• Request an independent medical review if services are denied

School-Based Services:

• File a complaint with the California Department of Education

• Request due process hearings for special education disputes

• Contact your local Family Resource Center for advocacy support

Steps When Services Are Delayed

Insurance Delays

1. Document Everything: Keep records of all communications, denials, and delays

2. Request Case Management: Ask your insurance for a dedicated case manager to help find providers

3. Invoke Timely Access Rights: Remind insurance of SB 221 requirements for 10-day appointment access

4. File Complaints: Use DMHC or CDI complaint processes if insurance doesn’t comply

5. Appeal Denials: Most insurance plans have internal and external appeal processes

Regional Center Delays

1. Request Expedited Review: If health/safety concerns exist, request 60-day instead of 120-day timeline

2. Document Urgency: Provide medical evidence of why delays would be harmful

3. Fair Hearing Rights: You can request a fair hearing if eligibility is denied or services delayed

4. Continued Services: If services are being reduced or stopped, you can request “aid paid pending” to continue services during appeals (must request within 10 days)

Important Legal Protections

No Caps on ABA Coverage

California law prohibits annual or lifetime caps on ABA therapy coverage. Mental health parity laws also prevent less favorable limitations on behavioral health benefits compared to medical benefits.

Provisional Eligibility (Ages 3-4)

Children ages 3-4 can receive provisional Regional Center services if they have significant functional limitations in at least two major life activity areas, even without a formal developmental disability diagnosis.

Appeal Rights

Families have extensive appeal rights for denied or delayed services:

• Fair hearings for Regional Center decisions (up to 90 days for resolution)

• Independent medical review for insurance denials

• Due process for special education disputes

Key Takeaways for Families

Know Your Rights: California has some of the strongest ABA coverage laws in the nation with no caps and strong timely access protections.

Document Everything: Keep detailed records of all requests, denials, and communications with providers and insurance.

Don’t Accept Illegal Waiting Lists: Regional Centers, school districts, and early intervention programs cannot legally place children on waiting lists.

Use Available Resources: Disability Rights California, Family Resource Centers, and Regional Center client rights advocates can provide free support and advocacy.

Act Quickly on Appeals: Most appeal processes have strict timelines, often requiring action within 10 days of receiving denial notices.

The legal framework strongly supports families’ rights to timely ABA services, and there are clear enforcement mechanisms when these rights are violated.