For years, California families navigating autism therapy services have faced an unnecessary and frustrating hurdle — repeated re-diagnosis requirements from insurance companies. Even when an autism spectrum disorder (ASD) diagnosis was clear and clinically valid, insurers could demand updated evaluations just to keep coverage going.
This often meant children and adults receiving Applied Behavior Analysis (ABA) therapy were pulled out of services or delayed for weeks, even months, while families scrambled to get new diagnostic reports. The process cost time, money, and emotional energy — and in many cases, it was not medically necessary.
On July 30, 2025, Governor Gavin...
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What AB 951 Changes
Starting January 1, 2026, California health insurers will no longer be able to require repeated diagnostic evaluations for ASD or pervasive developmental disorder (PDD) as a condition for continued therapy coverage.
- No More Unnecessary Re-Diagnoses – Once a diagnosis is established, insurers can’t demand another one just to continue therapy.
- Continuity of Care During Evaluations – If a re-evaluation is requested for clinical reasons, therapy must continue uninterrupted while it is completed.
- Clinical Oversight Over Insurer Policy – The decision to re-evaluate is now a clinical decision between the client, their family, and their care team — not a blanket insurance mandate.
- Stronger Enforcement – Willful violations are considered a criminal offense under California law, giving the statute real teeth.
Why This Matters for Families
For many California families, ABA therapy is a lifeline. Consistency is key for skill acquisition, behavior support, and long-term progress. Even short breaks can cause regression — sometimes taking months to regain lost ground.
Before AB 951, re-diagnosis demands could:
- Delay therapy for months while waiting for assessment appointments.
- Cost families thousands of dollars in evaluation fees not covered by insurance.
- Force parents to take time off work and pull children out of school for unnecessary testing.
- Create stress and uncertainty for both children and caregivers.
By removing this barrier, AB 951 ensures that once a diagnosis is in place, therapy can continue without disruption unless there is a genuine clinical reason to reassess.
Impact on ABA Providers
This law also streamlines processes for ABA providers. In the past, when insurers required updated diagnostic reports, providers often had to pause services or navigate complex temporary authorization processes. This created:
- Gaps in billing and revenue flow.
- Increased administrative load for staff.
- Frustrating conversations with families who blamed providers for delays caused by insurer policy.
With AB 951, providers can focus on delivering care instead of chasing paperwork. Authorization workflows can be simplified, and service continuity is more secure.
How This Fits Into the Larger Insurance Landscape
California is not the only state to face insurance-related challenges in autism care. Across the U.S., coverage requirements vary widely, and families in many states still encounter similar re-diagnosis rules.
While some insurers argue these evaluations help ensure accurate diagnosis and appropriate care, many autism experts — and now California lawmakers — recognize that repeated re-diagnoses are rarely clinically necessary. Instead, they can feel like a cost-control tactic that shifts burdens onto families and providers.
Potential Challenges Moving Forward
While AB 951 is a major win, there are still a few areas to watch:
- Implementation & Compliance – Providers and families will need to ensure insurers follow the new rules starting January 1, 2026.
- Out-of-State Coverage – Families with insurance plans regulated outside California may not benefit from this law.
- Clinical Re-Evaluation Processes – While the bill stops insurers from requiring unnecessary re-diagnoses, it still allows for clinically justified re-evaluations — and providers will need clear policies on when and how these occur.
What Providers Should Do Now
Even though the law doesn’t take effect until 2026, ABA providers in California can start preparing now:
- Review Your Authorization Workflows – Identify where re-diagnosis documentation has been required and how those steps can be removed after January 1, 2026.
- Educate Families – Let families know about the upcoming change so they can plan accordingly and reduce stress about future coverage.
- Train Your Admin Team – Make sure scheduling, billing, and authorization staff understand the new rules.
- Document Clinical Needs Clearly – If a re-evaluation is appropriate, have a standardized process and clear documentation so the decision is clinically sound.
- Track Compliance – Consider having a system to log any insurer requests that appear to violate the law, so you can address them quickly.
Why AB 951 Is a Model for Other States
This legislation reflects a growing push for insurance reforms that center on client needs rather than cost-containment. By making continuity of care the priority, California is setting an example that other states could follow.
For advocates, providers, and policymakers in other regions, AB 951 offers a template for legislation that:
- Protects families from unnecessary administrative burdens.
- Prevents treatment disruption.
- Places decision-making in the hands of clinicians and families.
Conclusion
AB 951 is more than a policy change — it’s a quality-of-life improvement for thousands of Californians. It removes a barrier that has long frustrated families and providers, ensuring that once an autism diagnosis is made, therapy can continue without bureaucratic roadblocks.
For ABA providers, it means fewer interruptions, more predictable authorizations, and an easier path to keeping services consistent. For families, it means less stress, fewer out-of-pocket expenses, and — most importantly — uninterrupted access to care.
