“Essential Health Benefits” Bulletin – Good news for autism! Will Washington state go green?

Late last week U.S. Department of Health and Human Services (HHS) indicated they will be permitting states to maintain coverage for autism behavior therapies, such as Applied Behavior Analysis (ABA), as part of their essential health benefits package when provisions of the new federal health care law take effect in 2014.
“HHS has committed to giving states flexibility in determining benefits,” said Lorri Unumb, Esq., vice president for state government affairs. “Entering 2012, 29 states representing 70 percent of the U.S. population have already made that decision and it is to require coverage of autism benefits. Today’s guidance gives states the freedom to maintain the coverage they have designed for their citizens without having to defray costs for ‘excess’ benefits.”

Under the Patient Protection and Affordable Care Act of 2010, the HHS was directed to determine an essential_health_benefits_bulletin package that would be offered in the individual and small group markets, both inside and outside of the Affordable Insurance Exchanges created under the law that begin operation in 2014. HHS, in its decision on Friday, gave the states the flexibility to choose from four types of health plans in establishing a benchmark for what services should be covered.

“Autism Speaks is optimistic this will enable states to continue to provide comprehensive autism therapies, such as ABA, as part of their essential health benefits package,” Unumb said. In the 29 states which have enacted autism insurance reform, Unumb said, most of the four plans would cover behavioral health treatments, such as ABA.

Here in Washington state however the disparity continues despite herculean efforts by advocates, multiple lawsuits testing one of the most comprehensive Mental Health Parity Laws in the nation.  As we ring in the new year, thousands of families are cautiously optimistic that Washington State Health Care Purchasing Agencies will catch up to the rest of the nation to provide our children, adolescents and adults with ASD’s basic health care benefits for treatment of autism.

Going for Green in 2012!!!


Arzu Forough

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