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ABA coverage to expand for Federal employees in 2017

March 01, 2016

The Office of Personnel Management, which manages the Federal Employees Health Benefits Program (FEHB), has directed its carriers not to exclude coverage of applied behavior analysis (ABA) starting next year. The FEHB program is the nation's largest employer-sponsored health benefits program, covering 8.2 million federal employees, retirees and dependents.

OPM urged its participating providers in 2012 for the first time to include ABA coverage, starting with their 2013 policies. Some did. In following years, OPM directed participating providers to either cover ABA or explain why they were not including the benefit. Gaps in coverage continued.  Now, in a letter dated February 26th, OPM has instructed that “that appropriate coverage of ABA treatment by all plans/options is necessary.”

The directive, made in OPM’s annual call letter for benefit and rate proposals from FEHB carriers, emphasized “the growing number of providers and the research linking behavioral interventions with positive outcomes.”  The letter further states that “We expect all carriers to offer clinically appropriate and medically necessary treatment for children diagnosed with ASD. [Carriers] may provide coverage for ABA as a fully case managed benefit, a pre-authorized service, and/or an in-network benefit only.”

Autism Speaks applauds OPM for stepping up and expanding ABA coverage for the 8 million people in FEHB plans.  We have been working for many years to ensure appropriate benefits for all individuals with autism, whatever their source of coverage.

“This is an important step forward for federal employees and their families.  It reflects a shared commitment that people with autism should have access to medically necessary care,” said Stuart Spielman, Senior Policy Advisor and Counsel at Autism Speaks

“This is absolutely huge news for the autism community.  We applaud OPM for stepping up to the plate and requiring ABA coverage for the 8 million people in FEHB plans,” said Lorri Unumb Esq., Vice President, State Government Affairs at Autism Speaks.