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In Healthcare Reform, Words Do Matter

This guest post is by Stuart Spielman, Senior Policy Advisor & Counsel for Autism Speaks.

On January 13 and 14, the Institute of Medicine (IOM), the health arm of the National Academy of Sciences, held a public workshop on a critical part of the new healthcare reform law, the essential health benefits package.  The law describes as essential the following general categories of items and services:

  1. Ambulatory patient services
  2. Emergency services
  3. Hospitalization
  4. Maternity and newborn care
  5. Mental health and substance use disorder services, including behavioral health treatment
  6. Prescription drugs
  7. Rehabilitative and habilitative services and devices
  8. Laboratory services
  9. Preventive and wellness services and chronic disease management
  10. Pediatric services, including oral and vision care

The task of the IOM, and ultimately the Secretary of Health and Human Services, whom the IOM is advising, is to develop the rules for using this list in designing health plans that will be offered beginning in 2014 through state insurance marketplaces.

For families affected by autism spectrum disorders(ASD), the fifth item on the list holds a special meaning.  The words “including behavioral health treatment” do not appear by accident; on the contrary, these words are part of the law because of amendments offered by Representative Mike Doyle, co-chair of the Congressional Autism Caucus, and Senator Robert Menendez.  As Senator Menendez pointed out at the time he offered his amendment.

Behavioral health treatments help to reinforce wanted behaviors and reduce unwanted behaviors, and the treatments are critical for individuals affected by autism and a variety of other disorders.

They can help a child to communicate and care for themselves; they can help that child from — stop him from hitting himself and those around him; they can enable a child to attend regular education classes, rather than special education classes; they can enable a child to live at home, rather than an institution.

Representative Doyle and Senator Menendez (joined by Senator Richard Durban and Senator Robert Casey) have separately written the IOM, urging that the behavioral health needs of people with autism spectrum disorders be addressed and that applied behavior analysis be included in all health plans.  The IOM and the Secretary should accept this counsel.

On January 18, the Interagency Autism Coordinating Committee (IACC) considered health care reform and insurance coverage issues as part of its meeting agenda.  These issues are likely to be further considered at the next full meeting of the committee on April 11.  The focus on health care reform at the IOM and the IACC present a critical opportunity to correct a decades-long pattern of discrimination against people with ASD.

See Stuart Spielman’s presentation to the IOM

  1. Mary Luce
    January 21, 2011 at 12:13 pm

    This is so critical. The Republicans in the House of Representatives have introduced a bill that would eradicate all autism coverage that is currently mandated in 23 states. This bill would allow insurance companies to sell insurance across state lines with the stated goal of allowing them to avoid state regulations, including autism coverage. If there is no national mandate, there will be no autism coverage if this bill, which has 60 sponsors, becomes law.

  1. October 12, 2011 at 4:23 pm

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