Reforms eliminate restrictions and gaps in coverage of medically necessary autism care
NEW YORK (August 3, 2019) – After more than a decade of advocacy by Autism Speaks, volunteer autism advocates and partners in the disability community, Tennessee is now the 50th state to take action clarifying that state-regulated health benefit plans must cover all medically necessary treatment for autism. On August 1, the Tennessee Department of Commerce and Insurance issued a bulletin requiring all individual, small and large group plans to cover medically necessary care for autism, including applied behavior analysis (ABA).
“People with autism and their families routinely face obstacles in accessing affordable care throughout their life span,” said Autism Speaks President and CEO Angela Geiger. “The autism community, including the volunteers who have tirelessly advocated for this coverage, appreciate the leadership of Tennessee’s Interim Commissioner Carter Lawrence for the positive impact this measure will have on the health care of so many people across the state.”
The bulletin effectively eliminates gaps and restrictions in autism coverage in the fully insured market. All fully insured health benefit plans regulated by the Tennessee Department of Commerce and Insurance must provide coverage for mental health conditions, including autism, as defined by the Diagnostic and Statistical Manual of Mental Disorders (DSM). Services must comply with the federal mental health parity law, the Paul Wellstone and Pete Dominici Mental Health Parity and Addiction Equity Act, which prohibits plans from imposing a financial requirement or treatment limit that is more restrictive than the predominant restrictions applied to substantially all medical or surgical benefits.
“In addition to clarifying that ABA must be a covered service in all fully insured plans, we believe this bulletin will prohibit plans from imposing restrictions on the number of treatment hours that currently exist in some Tennessee plan,” said Stuart Spielman, Autism Speaks senior vice president of advocacy. “In the coming months, we will work with the Department of Commerce and Insurance on the implications and implementation of the bulletin.”
Nationally, this marks a milestone. Efforts to expand autism insurance coverage began in the early 2000s and have continued ever since. While Autism Speaks applauds the advances in Tennessee, gaps and caps on coverage still exist in other state regulated and Medicaid plans as well as self-funded plans that are not regulated by state law. Autism Speaks remains committed to working with families, advocates and other stakeholders nationwide to ensure timely access to care, across the spectrum and throughout the life span.
Autism, or autism spectrum disorder, refers to a broad range of conditions characterized by challenges with social skills, repetitive behaviors, speech and nonverbal communication. We now know that there is not one autism but many subtypes, and each person with autism can have unique strengths and challenges. A combination of genetic and environmental factors influence the development of autism, and autism often is accompanied by medical issues such as GI disorders, seizures and sleep disturbances. Autism affects an estimated 1 in 59 children.
About Autism Speaks
Autism Speaks is dedicated to promoting solutions, across the spectrum and throughout the life span, for the needs of individuals with autism and their families. We do this through advocacy and support; increasing understanding and acceptance of people with autism spectrum disorder; and advancing research into causes and better interventions for autism spectrum disorder and related conditions
Article from Autism Speaks