Casey to Administration: Health Plans Under New Law Should Cover Autism As Standard Benefit

1 in 88 Children Affected by Autism, Costs Average Family $60k Per Year to Treat

Washington, DC- U.S. Senator Bob Casey (D-PA) called on the Department of Health and Human Services to include the behavioral health care needs of people with autism spectrum disorders (ASDs) in the Essential Health Benefits (EHBs) covered under the Affordable Care Act (ACA). In his letter to Secretary Sebelius, Casey noted that ASDs are the fastest-growing developmental disability in the United States, costing the average family about $60,000 per year to treat.

“It is critical that people with ASDs have access to resources like behavioral health care,” said Senator Casey. “That is why I have asked the Department of Health and Human Services to ensure that behavioral health treatment, including autism services, is adequately covered as a part of the essential health benefits requirements in the Affordable Care Act.”

The Centers for Disease Control and Prevention estimates that about 1 in 88 children in the United States are affected by autism.  Although there is no known cure for those suffering with ASDs, research shows that early intervention with specialized educational and behavioral therapy services can greatly improve a child’s development.

Under the Department’s current interpretation, as many as twenty-four states will continue to lack coverage of behavioral health treatment under the regulations that have been issued. Thirty-two states have enacted an autism insurance reform law for coverage in state-regulated health plans, but many still do not require coverage under ACA health plans.

The full text of Senator Casey’s letter can be found below:

The Honorable Kathleen Sebelius

Secretary

U.S. Department of Health and Human Services

200 Independence Avenue, SW

Washington, DC 20201

Dear Secretary Sebelius:

In light of the final rule  on Essential Health Benefits (EHBs) recently issued  by the Department of Health and Human Services, I write to express my ongoing concern that this rule does not adequately address the behavioral health care needs of people with autism spectrum disorders (ASDs).

ASDs are pervasive, chronic, and life-long developmental disorders with no cure. The Centers for Disease Control and Prevention estimates that about 1 in 88 children in the United States are affected by autism.  ASDs are the fastest-growing developmental disability in the United States and cost the average family about $60,000 per year to treat.  Although there is no known cure for those suffering with ASDs, research shows that early intervention with specialized educational and behavioral therapy services can greatly improve a child’s development.

Recognizing the importance and effectiveness of behavioral therapy services in treating those with ASDs, I supported Senator Menendez’s amendment to the Affordable Care Act (ACA) clarifying that behavioral health treatment is part of the mental health and substance use disorder services covered as essential health benefits under Section 1302(b).  Behavioral health treatment is explicitly included as a required essential health benefit under Section 1302(b), and I believe that the final rule is not consistent with Congressional intent.

Under the Department’s current interpretation, as many as twenty-four states will continue to lack coverage of behavioral health treatment under the regulations that have been issued. Thirty-two states have enacted an autism insurance reform law for coverage in state-regulated health plans, but many still do not require coverage under ACA health plans.

I therefore ask that you provide additional information on what steps your Department intends to take to ensure that behavioral health treatment, including autism services, are adequately covered in all states as a part of the essential health benefits requirements.

Sincerely,

Robert P. Casey, Jr.

United States Senator

 

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