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Lawmakers Press OPM on ABA Coverage

Dec 02, 2005

In response to inquiries from federal employees and congressional staffers lawmakers are calling on the regulatory body for health insurance companies covering federal workers to make available information on the extent of coverage the carriers provide for ABA (Applied Behavioral Analysis) therapy for children on the autism spectrum.

In their letter to Office of Personnel Management (OPM) Director Linda M. Springer, Congressional Autism Caucus Co-Chairs Mike Doyle (D-PA) and Chris Smith (R-NJ) are requesting of OPM to "immediately require all carriers within the [Federal Employee Health Benefit Program] to provide information on the extent of their coverage -- including any calendar year ceilings, provider qualification requirements, and/or other restrictions -- for behavior intervention/modification therapies such as Applied Behavioral Analysis."

The letter was issued at the start of Open Season for federal health benefits, when federal employees get to switch between insurance companies if they so choose. During past Open Seasons federal workers have been frustrated by insurance carriers refusing to provide information on their coverage for ABA, saying that such information was available to enrollees only. The Autism Caucus, in its latest letter, calls this situation "of little help" when employees compare insurance plans during Open Season.

Insurance companies within the Federal Employee Health Benefit (FEHB) system, as a rule, provide little to no coverage for ABA, but every year federal employees with children on the autism spectrum hold out for changes in insurance policies.

OPM, in theory, has the authority to require insurance companies within the FEHB system to cover ABA, but has not done so despite previous calls by the Autism Caucus to look into such a possibility given the numerous studies in support of ABA.

Last year, Mrs. Springer's predecessor, Kay Coles James, refused to consider the Caucus's request to look into "possible ways in which access to services like ABA could be expanded through the FEHB [system]." Quoting one unnamed "independent medical consultant," she called ABA "investigational" and not "medically necessary." She also indicated that she "polled" insurance companies on their views on ABA.

Mrs. Coles James resigned before her claims could be challenged.

Affected federal employees are hoping that Mrs. Springer will revisit the issue, and that before reaching a decision, she will look more closely at the existing scientific data regarding ABA.

Attachments:

congr to opm 11-16-05 pg 1.pdf

congr to opm 11-16-05 pg 2.pdf

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