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Friday, June 8, 2012

More on the OPM Decision

Autism Speaks comments on an important decision by the US Office of Personnel Management:
So what changed? OPM issued new guidance to the health plans that participate in the FEHB Program for policies they will renew or issue in 2013. The guidance, issued in mid-April, but not publicized until May 30, reads:

“The OPM Benefit Review Panel recently evaluated the status of Applied Behavior Analysis (ABA) for children with autism. Previously, ABA was considered to be an educational intervention and not covered under the FEHB Program. The Panel concluded that there is now sufficient evidence to categorize ABA as medical therapy. Accordingly, plans may propose benefit packages which include ABA.”

The implications of this determination are huge. Not only will the eight million federal beneficiaries finally have the opportunity to access coverage for ABA, but many other health insurance plans could end up following suit. The argument that ABA is purely educational has been at the core of the insurance industry’s opposition to providing coverage for behavioral health treatments for individuals with autism. That argument has now suffered a significant setback.