Doyle Calls on HHS to Require Behavioral Treatment Coverage for Individuals with Autism in Insurance Exchanges

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For Immediate Release Contact: Doyle Calls on HHS to Require Behavioral Treatment Coverage for Autistic Individuals in Insurance Exchanges Washington, DC – January 25, 2012 – U.S. Representative Mike Doyle (PA-14) announced today that he had contacted Health and Human Services (HHS) Secretary Kathleen Sebelius to urge her to require coverage of behavioral treatment for people with Autism Spectrum Disorders in all of the insurance plans that will participate in the health insurance exchanges that will open up across the country in 2014. On December 16, 2011, the HHS Center for Consumer Information and Insurance Oversight issued an “Essential Health Benefits Bulletin” to provide guidance to State agencies working to set up the health insurance exchanges required under the health care reform legislation signed into law by President Obama in 2010. (the Patient Protection and Affordable Care Act, P.L. 111-148). These health insurance exchanges will open across the country in 2014 to act like supermarkets where individuals, families, and small businesses can shop around for an insurance policy that best meets their needs. This bulletin left the decisions about what health care benefits must be covered by insurance plans competing for customers in these exchanges up to the States that are setting them up. “The evidence and scientific support for behavioral health services coverage for ASD is overwhelming,” Congressman Doyle observed in his letter to Secretary Sebelius. “That’s why I worked hard to ensure that behavioral treatment services like applied behavioral analysis would be covered by all of the insurance plans participating in the new health insurance exchanges.” As a result of Congressman Doyle’s efforts, Section 1302 of the Patient Protection and Affordable Care Act, P.L. 111-148, required that the “Essential Health Benefits” required of all plans participating in the health insurance exchanges include “Mental health and substance use disorder services, including behavioral health treatment.” The Essential Health Benefits Bulletin issued by HHS last month left States free to exclude behavioral health for individuals with autism spectrum disorders from the Essential Health Benefits they require insurance policies to cover. Congressman Doyle’s letter to Secretary Sebelius urged HHS to revise its guidance on Essential Health Benefits to require insurance plans participating in any health insurance exchange to cover behavioral health treatment services like applied behavioral analysis for individuals with autism spectrum disorders. “Insurance companies shouldn’t be able to deny any group of patients coverage for medical treatment that has been proven to be both safe and incredibly effective,” Congressman Doyle added. “That’s clearly what’s been happening with behavioral health treatments for people with autism. I will continue to push to ensure that behavioral health treatment services for individuals with autism are required as Essential Health Benefits as of 2014.” Click here to see the letter. ###