L'administration Obama a poussé pour assurer la couverture de l'ABA pour le traitement de l'autisme

27 octobre 2012

L'administration Obama a poussé pour assurer la couverture de l'ABA pour le traitement de l'autisme

Obama administration pushed to ensure coverage of ABA for treatment of autism
(article publié dans examiner)

A group of Democratic senators sent a letter this week to U.S. Secretary of Health and Human Services Kathleen Sebelius recommending mandated insurance coverage of autism treatment in the form of applied behavior analysis (ABA) therapy.

A group of Democratic senators, including Senators Kirsten Gillibrand, (D-NY), Barbara Boxer, (D-CA), Al Franken, (D-MN), and Sherrod Brown, (D-OH), sent a letter this week to U.S. Secretary of Health and Human Services Kathleen Sebelius recommending mandated insurance coverage of autism treatment in the form of applied behavior analysis (ABA) therapy.

“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...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.”

The Office of Personnel Management (OPM) has already mandated coverage of ABA therapy for federal employees. Their review panel determined that based on ample scientific and empirical evidence, ABA therapy qualifies as a medical treatment, rather than purely educational and will apply to health plans for federal workers beginning in 2013.

While the Affordable Care Act specifies various types of health care services that insurers must include in all plans when it's fully implemented on January 1, 2014, including mental health and behavioral services, ABA therapy hasn't been specifically stipulated as essential for the treatment of autism. This particular interpretation has been left to be determined at the state level, with ABA therapy already covered under insurance mandates in 32 states such as California. But this group of senators, as well as many autism advocates, do not believe that is enough.

The full letter follows:

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.