he Politics of Autism includes an extensive discussion of insurance coverage.
Beginning in 2017, all insurance carriers participating in the Federal Employees Health Benefits Program must cover a popular therapy for children with some form of autism, according to the Office of Personnel Management.
Since 2013, FEHBP insurance carriers have had the option of covering applied behavior analysis, or ABA, as a medical treatment (rather than an educational intervention) for enrollees’ children with disorders on the autism spectrum. OPM told FEHBP providers in aFeb. 26 letter that for the 2017 plan year they “may no longer exclude ABA” as a treatment for ASD kids. “We expect all carriers to offer clinically appropriate and medically necessary treatment for children diagnosed with ASD," the letter said. "You may provide coverage for ABA as a fully case managed benefit, a pre-authorized service, and/or an in-network benefit only."
More FEHBP carriers have been providing the covered benefit in the past several years, OPM noted, “particularly among carriers with state and local service areas.” ABA has been clinically proven to help increase an autistic child’s I.Q., language abilities and coping skills.
