The Affordable Care Act (ACA), the federal health care law enacted in 2010, directed the HHS to define a package of 10 essential health benefits (EHB) for individual and small group health plans, many of which will have to cover these benefits beginning in 2014. Congress specified that one of the EHB categories must be “mental health and substance use disorder services, including behavioral health treatment.” The words “including behavioral health treatment” were added to ensure coverage for individuals on the autism spectrum and for those with other developmental disabilities.
But under the new HHS proposal, coverage of behavioral health treatment would be determined by whether or not a state had its own autism insurance reform law on the books. Specifically, any state-mandated benefits, such as autism insurance reform laws, added after December 31, 2011, cannot be part of the EHB for 2014 and 2015, under the new HHS proposal. Each state is to select a single health plan as its benchmark for health benefits, then supplement that plan as necessary to conform to the 10 benefit categories.
By the end of 2011, 29 states had enacted comprehensive autism mandates. Depending on the choice of benchmark, families living in these states may have autism coverage as part of the EHB. Families living in the other 21 states – including Michigan, Alaska, and Delaware, which enacted autism insurance laws in 2012 – may not be so fortunate.