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ABA Coverage: The Tide Is Turning

The tide continues to turn in favor of wider coverage for Applied Behavior Analysis (ABA). In Capitol Hill testimony last week, the 60,000-member American Academy of Pediatrics (AAP) publicly endorsed the use of ABA treatments “when determined appropriate by physicians within a medical home, in close consultation with families.”

ABA is the most widely used behavioral intervention employed to treat autism, but the insurance industry has fought at every level to deny coverage, claiming it is “experimental” or purely educational. Last week’s testimony by Dr. Vera Tait, an associate executive director at AAP, helped to further deflate those claims. 

Testifying before a Senate Armed Services subcommittee, Tait urged the Department of Defense to be more flexible in providing ABA services to military families as new data emerges. Military families now are denied ABA coverage under basic TRICARE coverage because the DoD regards the treatment as educational rather than medical. 

That same logic had been employed by the federal government until earlier this year to deny ABA coverage to the nation’s eight million civilian federal employees, retirees, and their dependents. But in April, the federal agency that manages the civilian health insurance program finally recognized ABA as a medical therapy eligible for coverage.

Meanwhile, in the private market, Alaska just became the 31st state to require state-regulated health insurance plans by law to cover ABA and Delaware is on the verge of enacting similar legislation. Nearly 75 percent of the U.S. population now lives in a state with an autism insurance reform law requiring some level of ABA coverage.

Tait said the AAP recommends a minimum level of health benefits for all infants, children and youth, including behavioral health and habilitative services. Autism spectrum disorders generally are not “curable,” Tait said, requiring complex care for the child along with services for the family. 

“Effective medical care and treatment can have a positive impact on the habilitative progress and quality of life for the child,” Tait told the Senate panel. “Therapeutic interventions, including behavioral strategies and habilitative therapies, are the cornerstones of care for ASDs.” 

She noted that children with ASDs also require help with sleep problems, obsessive behaviors, hygiene, self-care skills, diet and self-injurious behaviors. 

“The effectiveness of ABA-based interventions in ASDs has been well-documented through a long history of research in university and community settings,” Tait said. “Children who receive early intensive behavioral treatment have been shown to make substantial gains in cognition, language, academic performance, and adaptive behavior as well as some measures of social behavior, and their outcomes have been significantly better than those of children in control groups. 
 
“In short, though more research is needed, ABA has both long-term empirical and research data to demonstrate its effectiveness in helping children who are diagnosed with ASD, and AAP has endorsed the use of ABA treatments when determined appropriate by physicians within a medical home, in close consultation with families,” Tait said.

The Autism Speaks blog features opinions from people throughout the autism community. Each blog represents the point of view of the author and does not necessarily reflect Autism Speaks' beliefs or point of view.