Autism Speaks and Federal Employees Health Benefits
Autism Speaks hailed today’s announcement by the federal government, the
nation’s largest employer, that Applied Behavior Analysis (ABA), the most widely
used behavioral intervention used to treat autism, is a “medical” therapy that
qualifies for health insurance coverage, rather than an “educational”
service.
The decision by the U.S. Office of Personnel Management (OPM)
involves health insurance coverage provided to the nation’s eight million
federal employees, retirees, and dependents, under the Federal Employees Health
Benefits (FEHB) Program. It could have even more far-reaching implications on
the health insurance benefits provided all Americans living with autism, as it
will be much harder for insurance companies to continue denying coverage for ABA
treatment.
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“The OPM decision directly contradicts a long-standing
insurance industry claim that ABA therapy is not ‘medical,’ but rather
‘educational’ - provided by the schools at taxpayer expense,” said Peter Bell,
Autism Speaks executive vice president for programs and services. “Now, tens of
thousands of families will have better access to more affordable, critical ABA
treatment.”
The decision was rendered in the form of guidance to
insurers who participate in the FEHB Program for policies that will be renewed
or issued starting in 2013. The OPM decision does not require the insurers to
cover ABA, but rather allows them to offer the coverage as it does many other
medical treatments. The guidance 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.”
Autism Speaks has fought to provide
families insurance coverage for ABA therapy through state-regulated plans,
self-funded group plans that are regulated under federal law, the FEHB Program,
and TRICARE for military families. In each instance, opposition to covering ABA
treatment has been based in large part on the claim that ABA is educational,
rather than medical.
