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National Standard Urged For Autism Coverage

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A federal advisory panel is calling on the Obama administration to establish a minimum standard for autism insurance coverage.

The Interagency Autism Coordinating Committee, or IACC, voted unanimously on Tuesday to send a letter to U.S. Secretary of Health and Human Services Kathleen Sebelius highlighting the vast differences emerging as states determine what type of treatments insurance providers will be required to cover under the new health care reform law.

At present, the committee indicated that about half of states are expected to include treatment of applied behavioral analysis, or ABA therapy, and other autism-specific behavioral interventions in their “essential health benefits” — 10 categories of treatment that most plans will be required to provide starting next year. Other states may mandate that little to no autism treatments are covered by health insurers, the panel said.

The inconsistency among states is cause for alarm, according to the IACC, a committee made up of government officials and members of the autism community.

“If benchmark plans in all states do not provide robust and consistent coverage of autism-specific behavioral interventions, we are concerned that some families will be forced to migrate to find coverage while others will not have access to treatments that can mitigate lifelong disability,” the committee wrote in a draft letter to Sebelius that is expected to be finalized and sent in the coming days. “A federal minimum standard of autism coverage should be set.”

The letter from the IACC comes just weeks after the Obama administration declined to include any mention of ABA or autism behavioral therapy in final rules regulating the essential benefits portion of the health care act.

Advocates had hoped that such therapy would be included under the law’s mandate to cover “mental health and substance use disorder services, including behavioral health treatment.”

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Comments (5 Responses)

  1. Marjorie Madfis says:

    and what about ERISA – plans that are not covered by State insurance laws but by Federal law? This means most of the Fortune 500 companies. They don’t have to comply with their State laws even if Autism and DD is covered by their State law. For example, even speech therapy and OT for kids with DD are not covered by my insurance plan (unless you lost speech or motor skills because of a stroke for example)

  2. discernment says:

    If your coverage is under ERISA, did you know…..

    If benefits are improperly denied, the insurance company cannot be sued for any resulting injury or wrongful death, regardless of whether it acted in bad faith in denying benefits.

    ERISA preempts all conflicting state laws, including state statutes prohibiting unfair claims practices and causes of action arising under state common law for insurance bad faith.

    There is no right to a jury trial in ERISA benefits actions.

    Although Americans normally take for granted the right to testify on their behalf, plaintiffs have no right to present live testimony in ERISA bench trials, in which the judge simply reads through the documents which formed the record originally before the ERISA plan administrator and performs de novo review.

    Punitive damages are not allowed in actions for ERISA benefits.

    Did you know it was this bad? Search “ERISA” on wikipedia (where this came from) and see for yourself. The large corporations routinely screw the disabled to save money they could just write off their taxes anyway. Funny, they always seem to be able to afford to pay ‘zillion dollar bonuses to the CEO’s.

  3. Tacitus says:

    The changes wrought by any of the so-called “treatments” for autism are superficial at best, and mostly range from non-existent to harmful. Making people look less disabled, making people feel as if they are doing something, these are not the goals of the ACA. It was to arrest the rising cost of healthcare and to give people access to genuine treatments that help the people receiving them. People should not be lobbying congress to ignore the lack of scientific evidence in favor of their pet theory.

  4. barbara morgan says:

    Sorry, but guess what: Autism isn’t the ONLY issue out there! Why should there be a push to guarantee insurance coverage for one disabling condition and not another? We had to abandon private therapies for our son who has Down Syndrome when our employee healthcare provider changed the policy to only cover therapy to help RECOVER LOST abilities. Since our son has always had significant language delays, he was deemed ineligible. I don’t understand why those children and adults with I/DD due to genetic, chromosomal anomalies, or undefined conditions should be ignored in legislation. Aren’t their lives important anymore?

  5. SWilliamson says:

    Barbara Morgan, you do realize the numbers for autism don’t you? It is now estimated to be 1 in 50. With numbers that large, yes, I do strongly believe there needs to be a push for ABA therapy and other therapies. I understand where you’re coming from because I have a son with Autism who is unable to get the treatment he needs. So, while this is just ONE of MANY problems we have with our healthcare, remember as strongly as you feel down syndrome care should be addressed, parents of children with Autism feel autism care should be addressed. Also, ABA therapy IS scientifically proven to be effective for those with Autism.

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