Children/Families w/ Autism to Get More Insurance Coverage AccessSmith, co-chair of the Autism Caucus, praises decision to include therapy in federal employee healthcare plans
Beginning next year, federal employees who have children with Autism Spectrum Disorder (ASD), will have access to a key, intervention therapy proven to bring about positive behavior change and assist in a child’s long term development, said U.S. Rep. Chris Smith (NJ-04), the co-chairman of the Congressional Autism Caucus.
Smith said late last week the Office of Personnel Management (OPM), which manages the Federal Employees Health Benefits Program (FEHBP), sent a letter directing insurance companies to cover applied behavior analysis (ABA) starting in 2017.
“This decision is a milestone that will help ensure families across the country using ABA therapy will no longer have to pay the full out-of-pocket costs, and that public servants in every state will have access to an insurance plan that meets the needs of individuals on the spectrum,” said Smith, the author of three laws to increase federal research efforts and assist families impacted by ASD.
“Currently, federal employees in only 27 states have the option of an FEHB plan that covers ABA treatment, and even in those states, coverage is not consistent,” Smith continued. “Despite New Jersey having the highest prevalence rate of ASD found in CDC studies, families across our state participating in an FEHB plan do not have a single plan that covers ABA therapy.” There are more than 24,000 civilian federal employees in New Jersey, Smith said.
ABA is an evidence based behavior intervention that is widely accepted among health care professionals as an effective treatment that improves a variety of skills by encouraging positive behaviors and discouraging negative behaviors.
“We know that early diagnosis and intervention services are critical to the long term development of a child with autism,” said Smith. “In addition to universal and early detection screening, interventions such as ABA therapy are important tools that helps provide children with ASD an opportunity to live to their full potential.”
Smith noted that the improvement in federal employees’ health plans is an important step toward the larger goal of securing ABA coverage for children and families in all insurance plans for public and private employees alike.
“We have seen inconsistent coverage for ABA across the board, across state lines,” Smith said. “As more insurance plans provide coverage of ABA, more families are helped. Ideally, the remaining programs will be inspired to follow suit and make similar changes for their clients.”
Smith noted that OPM had begun to encourage insurance providers to extend coverage of ABA through ‘carrier letters’ in recent years, but the uptake was slow. Thus the decision this year to require each plan to provide ABA coverage is most welcome. In its letter notifying carriers of the change in policy, the federal personnel management office said in part: “OPM has now determined that appropriate coverage of ABA treatment by all plans/options is necessary for the efficient and effective operation of FEHB’s individual choice insurance model. Therefore, for the 2017 plan year, carriers may no longer exclude ABA for the treatment of Autism Spectrum Disorder (ASD). We expect all carriers to offer clinically appropriate and medically necessary treatment for children diagnosed with ASD.”
Prevalence rates of ASD have been increasing at an alarming rate and nationally, 1 in 68 children has ASD according to the Centers for Disease Control (CDC). In New Jersey, that number is 1 in 45.
Smith has been a legislative power house pushing though new laws to help children with autism and their families. His most recent law, Autism Collaboration, Accountability, Research, Education and Support Act of 2014—(Autism CARES Act/ Public Law 113-157), authorized $1.3 billion over five years for research into autism and urged federal agencies to examine and anticipate needs for autistic children who are “aging out” of current programs and need different assistance as adults.
He also wrote legislation adopted in 2000, that created the first, national, comprehensive federal response to combat autism. The Autism Statistics, Surveillance, Research and Epidemiology (ASSURE) Act—which later became Title I of P.L. 106-310 —authorized grants and contracts for the collection, analysis, and reporting of data on autism and pervasive developmental disabilities, and established regional centers of excellence in autism surveillance and epidemiology. He is also the author of The Combating Autism Reauthorization Act (P.L 112-32) which was made law in 2011.
The origins of the laws stem from nearly 20 years ago, when Bobbie and Billy Gallagher of Ocean County, N.J, parents of two small children with autism, visited Smith’s district office looking for help. The couple believed their town had a disproportionate number of students with autism and wanted action. Smith petitioned the CDC and other federal agencies to investigate. CDC determined that autism rates had increased not just in the Gallagher’s area, but across the country. Soon after, Smith introduced the ASSURE Act, HR 274, to authorize grants and contracts for the collection, analysis, and reporting of data on autism and pervasive developmental disabilities. Smith’s ASSURE Act was enacted as Title 1 of The Children Health Act of 2000 and now forms the baseline of much of the federal work in autism today.