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Autism Speaks: New Federal Health Care Rules Come Up Short on Autism

February 20, 2013

NEW YORK (February 21, 2013) -- The expanded access to health care promised through the Affordable Care Act (ACA) would fall short with autism under new federal regulations that fail to require every state to include coverage for behavioral health treatment as the law required, said Peter Bell, Autism Speaks' executive vice president for programs and services. Autism is the fastest growing developmental disability in the United States with an estimated 1 of every 88 children now diagnosed with an autism spectrum disorder.

Bell was responding to final rules made public yesterday by the U.S. Department of Health and Human Services (HHS) regarding the 10 "essential health benefits" every state must include in their new ACA health insurance marketplaces that start operation next year. Even though coverage for behavioral health treatment, including applied behavior analysis (ABA), was required by Congress, as many as 24 states continue to lack this coverage under the HHS regulations.

Among these states are Pennsylvania, Florida and Virginia which require the coverage by law for state-regulated health plans, but would not require it through their new ACA health plans. A total of 32 states have passed autism insurance reform laws requiring autism-related coverage in state-regulated health plans.

“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 Bell. "On the other hand, we are encouraged that the flexible approach HHS has adopted could ultimately lead to more states including behavior treatment benefits for autism.

"The habilitative services category may offer a fallback. States that do not have an ABA benefit should step up – now – and determine that this vital coverage is part of their benchmark plan.”

Green = States that require autism coverage in state-regulated and ACA health plans
Dark Green = States that require autism coverage in ACA plans only
Red = States that require autism coverage in state-regulated health plans or for state employees, but not ACA health plans
White = States that require no autism coverage

For instance, Ohio, which is not one of the 32 states to enact an autism insurance reform law, will be permitted to require the coverage in its ACA health insurance marketplace under an order signed in December by Gov. John Kasich. California, New York, Michigan, Delaware and Alaska, all of which passed their state laws after the ACA was enacted, also will be permitted to include behavioral health treatment in their ACA health plans.

"Our goal continues to be autism insurance coverage in all health plans in all 50 states," said Bell. "The HHS regulations are disappointing. Geography shouldn’t dictate whether a person with autism gets needed care.”

The final federal model plan adopted by HHS should include specific coverage for behavioral health treatment, said Bell.