Despite a heavy lobbying effort, the Obama administration declined to include autism therapy in final rules this week defining what must be covered by insurers under health care reform.
Many states have established mandates in recent years requiring at least some health insurance plans to include coverage of behavior therapy to treat autism. But with the passage of the 2010 health care reform law, advocates were hopeful that a nationwide standard would be established.
Under the federal law, most health insurance plans will be required to cover 10 so-called “essential health benefits” starting next year, one of which is “mental health and substance use disorder services, including behavioral health treatment.”
Autism advocates urged regulators to include a requirement that applied behavioral analysis, or ABA therapy, be covered in rules governing what exactly qualified as a “behavioral health treatment,” but a final rule issued this week makes no mention of the treatment.
The result, advocates say, is that coverage for ABA and other autism behavior therapy will likely remain defined by the state a family lives in.
“Behavioral health treatment, including ABA, was specifically written into the law by Congress as an essential health benefit, yet that requirement seems to have disappeared from the new HHS regulations,” said Peter Bell, executive vice president for programs and services at Autism Speaks, which has lobbied for ABA coverage mandates.
“Geography shouldn’t dictate whether a person with autism gets needed care,” said Bell who called the new regulations “disappointing.”
The criticism comes as Obama administration officials hailed the regulations for providing expanded coverage of mental health benefits, which have been excluded from nearly 20 percent of individuals’ insurance plans in the past. What’s more, Kathleen Sebelius, secretary of health and human services, said that the new rules would make it simpler for consumers to shop for and compare health insurance plans.
In addition to mental health, the new regulations will mandate coverage of maternity, habilitative services and preventive care, among a handful of other broad categories, beginning in 2014. The Obama administration largely left it to the states, however, to determine specific requirements within each category.
In an analysis of plans submitted so far, Autism Speaks estimates that as many as 24 states may leave out autism coverage, including some which had previously passed laws to require it.
Officials from the U.S. Department of Health and Human Services did not initially respond to requests for comment regarding the decision not to include ABA therapy within the federal regulations. But in an email to Disability Scoop on Friday, agency spokesman Fabien Levy wrote, “states were given the option to define habilitative services and many states took the opportunity to do so on their own.”