Senators urge feds to mandate coverage of autism therapy

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Four U.S. Senators recently wrote a letter to the U.S. Department of Health and Human Services, urging Secretary Kathleen Sebelius to require insurers to cover applied behavioral analysis therapy as part of the reforms under the Affordable Care Act.

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Letter Calls for Coverage

“All people affected by autism should have access to needed treatment,” the letter states. “That will not occur under the guidance issued by the Department of Health and Human Services… 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.”

ABA therapy, which can cost families as much as $50,000 per year, is the standard intensive therapy program for young children with autism. The Affordable Care Act, beginning in 2014, requires all insurance plans to cover 10 categories of health care, including one category for “mental health and substance use disorder services, including behavioral health treatment.”

However, states have large discretion to determine which services are covered under those categories. As a result, many insurance companies are likely to continue to argue that ABA therapy is not a medically necessary treatment, or that it is only experimental, among other arguments.

The Office of Office of Personnel Management has already announced that, beginning in 2013, insurance plans for federal employees must cover ABA therapy, according to an article in the Examiner. The therapy is also mandated in 32 states.

The letter’s signees are senators Kirsten Gillibrand (D-NY), Barbara Boxer (D-CA), Al Franken (D-MN), and Sherrod Brown (D-OH).

“Clinical trials have shown that early intensive behavioral intervention significantly increases IQ, language abilities, and daily living skills, while reducing the debilitating symptoms of autism,” the letter states. “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….These advances have changed the trajectory of children’s lives and given new hope to families and caregivers.”