Letter to Secretary Sebelius

Letter

By:  Kirsten Gillibrand Al Franken Sherrod Brown Barbara Boxer
Date: Oct. 15, 2012
Location: Washington, DC

U.S. Senators Kirsten Gillibrand (D-NY), Barbara Boxer (D-CA), Al Franken (D-MN), and Sherrod Brown (D-OH) today pushed the federal government to require all health care plans to cover autism treatment by 2014. The Department of Health and Human Services (HHS) recently released guidelines that leave it up to states to decide whether or not to include autism care in statewide health plans. Senators urged HHS Secretary Kathleen Sebelius to clarify that a kind of autism treatment known as applied behavior analysis (ABA) is part of the essential health benefits that must be covered under health care plans by 2014.

Senators Gillibrand, Boxer, Franken, and Brown wrote in a letter to Secretary Sebelius, "Rather than setting a uniformly high national standard, the [HHS] guidance allows states to select benchmark plans that neglect or skimp on autism care… If the guidance is not changed, children and adults with autism will not be better off when Affordable Insurance Exchanges launch in 2014 than they are today… Congress recognized autism as a top national health priority. We intended not to preserve the status quo but to reduce the burdens faced by families across the nation. In finalizing the guidance for the essential health benefits, we urge you to clarify behavioral health treatment as including ABA for individuals on the autism spectrum."

In December 2011, HHS issued the Essential Health Benefits (EHB) Bulletin which allows each state to "benchmark" its own essential benefits package to one of several existing employer-based insurance plans. Currently, 32 states require some form of autism coverage, including New York. Even states with laws in place can choose benchmark plans that provide only a portion of ABA coverage. States without mandates are not required to cover autism treatment at all. The guidelines also require states that lack autism insurance laws or enacted autism insurance laws in 2012 to defray the cost of any ABA coverage provided through a state health insurance exchange.

The elected officials called for a uniform federal standard, regardless of one's health insurance plan or state's insurance law, to ensure that families and children across the country have access to affordable treatment.

Behavioral interventions that use the methods of applied behavior analysis (ABA) have become widely accepted among health care professionals as an effective treatment for autism.

This past June, the American Academy of Pediatrics endorsed the use of ABA treatments when determined appropriate by physicians within a medical home and in close consultation with families.

Full text of the Senators' letter is below:

Dear Secretary Sebelius:

As you recently noted in remarks to the Interagency Autism Coordinating Committee, access to affordable, quality health care is critical for people with autism and their families. Beginning in 2014, many children and adults with autism will obtain health insurance through qualified health plans that cover the ten categories of essential health benefits specified in the Affordable Care Act. All qualified health plans must provide "mental health and substance use disorder services, including behavioral health treatment." We write to you now out of a shared belief that the benefits offered under this category must be robust and readily available to children and adults with autism.

Clinical trials have shown that early intensive behavioral intervention significantly increases IQ, language abilities, and daily living skills, while reducing the debilitating symptoms of autism. Behavioral interventions that use the methods of applied behavior analysis (ABA) have become widely accepted among health care professionals as an effective treatment for autism. Through decades of research, the field of behavior analysis has developed many techniques for increasing useful behaviors and reducing those that may cause harm or interfere with learning. These advances have changed the trajectory of children's lives and given new hope to families and caregivers. In testimony this past June before the Senate Armed Services Committee Subcommittee on Personnel, the American Academy of Pediatrics endorsed the use of ABA treatments when determined appropriate by physicians within a medical home and in close consultation with families.

Too often, cost and discriminatory insurance company practices have impeded access to these treatments, preventing their promise from being fully realized. But the barriers are coming down. Thirty-two states currently mandate comprehensive autism care, and starting in 2013 Federal Employees Health Benefits Program plans may offer benefits packages that include ABA.

All people affected by autism should have access to needed treatment. That will not occur under the guidance issued by the Department of Health and Human Services (Essential Health Benefits Bulletin and Frequently Asked Questions on Essential Health Benefits Bulletin). Rather than setting a uniformly high national standard, the guidance allows states to select benchmark plans that neglect or skimp on autism care. The guidance requires states without ABA mandates and states with ABA mandates enacted in 2012 either to defray the cost of ABA coverage or provide no ABA coverage. If the guidance is not changed, children and adults with autism will not be better off when Affordable Insurance Exchanges launch in 2014 than they are today.

According to the December 2011 Essential Health Benefits Bulletin, the benefit category "mental health and substance use disorder services, including behavioral health treatment" should cover the behavioral health services associated with autism treatments and therapies. In our deliberations over the Affordable Care Act, Congress recognized autism as a top national health priority. We intended not to preserve the status quo but to reduce the burdens faced by families across the nation. In finalizing the guidance for the essential health benefits, we urge you to clarify behavioral health treatment as including ABA for individuals on the autism spectrum.