ABA Therapy Coverage Campaign

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Small Setback, but the Fight Continues

Nov 18, 2004

The government entity in charge of federal health insurance policy has denied our request to have ABA therapy covered under health plans available to federal employees.

The denial came in a letter by Office of Personnel Management (OPM) Director Kay Coles James in which she, quoting an unnamed "expert independent medical consultant," claims that ABA therapy has not "proven [itself] ... beneficial" or "medically necessary." Furthermore, Mrs. Coles James writes that OPM polled health insurance companies within the federal system regarding coverage for ABA. According to her findings, all of them considered ABA therapy to be "experimental or investigational" (for the full text of her letter, check the attached PDF file).

Mrs. Coles James's letter was in response to letters written on our behalf by Congressional Autism Caucus co-chairmen, Reps. Chris Smith (R-NJ) and Mike Doyle (D-PA), a number of other lawmakers as well as by American Federation of Government Employees National President, John Gage, who represents some 600,000 federal workers. All of these individuals, in separate appeals, called on Mrs. Coles James to consider the benefits of early intervention and to look for ways to amend federal insurance guidelines to include coverage for ABA therapy.

Mrs. Coles James's response came as no surprise to us. Somehow we knew that it would be in line with the position of the insurance companies which she "polled." However, it was quite astonishing that she actually admitted that polling insurance companies was the methodology she used to help her reach what one might consider was a foregone conclusion. Why did she not poll the 190+ members or at least the leadership of the Congressional Autism Caucus? Why did she not poll parents of autistic children who don't consider it experimental to spend several thousand dollars a month to provide their children with a therapy that is deemed to give them their only promising chance at a fair life? Why did she not poll the other group of parents who despair every day, because they cannot afford a therapy which for their child could mean the difference between a functional life and life in an institution? Why did she not consult a 1999 U.S. Surgeon General's report that recognizes and extols the benefits of early behavioral intervention. It seems that, for whatever reason, her mind was already made up from the get go. All she needed was a few allies that would support her position, and she knew exactly where to find them.

In any event, Mrs. Coles James's denial of our request is not the end of the road for us. We are already working on the next steps in this process, and will keep you posted. If you would like to join our mailing list, please send us your address.

In the meantime, tell Mrs. Kay Coles James what you think of her decision by e-mailing her at director@opm.gov

Please make sure to copy us at abatcc@solvethepuzzle.org

Attachments:

OPM response.pdf

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