U.S. Senators Kirsten Gillibrand (D-NY), Barbara Boxer (D-CA), Al Franken (D-MN), and Sherrod Brown (D-OH) today pushed the federal government to require all health care plans to cover autism treatment by 2014. The Department of Health and Human Services (HHS) recently released guidelines that leave it up to states to decide whether or not to include autism care in statewide health plans. Senators urged HHS Secretary Kathleen Sebelius to clarify that a kind of autism treatment known as applied behavior analysis (ABA) is part of the essential health benefits that must be covered under health care plans by 2014.
Senators Gillibrand, Boxer, Franken, and Brown wrote in a letter to Secretary Sebelius, “Rather than setting a uniformly high national standard, the [HHS] guidance allows states to select benchmark plans that neglect or skimp on autism care… If the guidance is not changed, children and adults with autism will not be better off when Affordable Insurance Exchanges launch in 2014 than they are today… Congress recognized autism as a top national health priority. We intended not to preserve the status quo but to reduce the burdens faced by families across the nation. In finalizing the guidance for the essential health benefits, we urge you to clarify behavioral health treatment as including ABA for individuals on the autism spectrum.”
In December 2011, HHS issued the Essential Health Benefits (EHB) Bulletin which allows each state to “benchmark” its own essential benefits package to one of several existing employer-based insurance plans. Currently, 32 states require some form of autism coverage, including New York. Even states with laws in place can choose benchmark plans that provide only a portion of ABA coverage. States without mandates are not required to cover autism treatment at all. The guidelines also require states that lack autism insurance laws or enacted autism insurance laws in 2012 to defray the cost of any ABA coverage provided through a state health insurance exchange.
The elected officials called for a uniform federal standard, regardless of one’s health insurance plan or state’s insurance law, to ensure that families and children across the country have access to affordable treatment.
Behavioral interventions that use the methods of applied behavior analysis (ABA) have become widely accepted among health care professionals as an effective treatment for autism.
This past June, the American Academy of Pediatrics endorsed the use of ABA treatments when determined appropriate by physicians within a medical home and in close consultation with families.