United States Office of Personnel Management

Government Requires Insurance Programs to Cover Autism Treatment

The U.S. government has made what is being called a significant step for the autism community. This week the Office of Personnel Management (OPM) stated that beginning in 2017, all health plans under the Federal Employees Health Benefits Program will cover Applied Behavior Analysis (ABA) for children who are on the autism spectrum. The Federal Employees Health Benefits Program extends to federal employees, retirees and their dependents and covers an estimated eight million people.


Beginning in 2013, federal officials began to encourage department heads to include the coverage of ABA in their benefit plans. The push had some success, but despite the emphasis, many federal agencies still opted not to provide coverage to employees and their dependents. “OPM has now determined that appropriate coverage of ABA treatment by all plans/options is necessary,” a letter OPM sent last week to insurance carriers interested in funding the service. “Therefore, for the 2017 plan year, carriers may no longer exclude ABA for the treatment of autism spectrum disorder (ASD). We expect all carriers to offer clinically appropriate and medically necessary treatment for children with ASD. We expect all carriers to offer clinically appropriate and medically necessary treatment for children diagnosed with ASD.”

Related: Everything You Have to Know About Autism

ABA is a scientifically proven method that attempts to reinforce desired behavior by marrying the behavior with rewards. The goal is to increase valuable behavior and reduce habits that may interfere with learning. ABA focuses on improving common skills such as looking, listening, reading, conversing, and understanding others. In addition to increasing, teaching and reinforcing positive behaviors, ABA also aims to restrict and reduce negative behaviors.

This effective treatment measures its success quantifiably and specifically, according to the Center for Autism: “For example, a goal to reduce a child’s aggressive behavior might define ‘aggression’ as: ‘attempts, episodes or occurrences (each separated by 10 seconds) of biting, scratching, pinching or pulling hair.’ ‘Initiating social interaction with peers’ might be defined as: ‘looking at classmate and verbalizing an appropriate greeting.'”

Autism impacts a large number of children. According to the Centers for Disease Control and Prevention, 1 in 68 children fall on the autism spectrum. It affects all races, ethnicities and socioeconomic classes, although it is reportedly more common in boys (1 in 48) than girls (1 in 189).

The new requirement is being hailed as a step in the right direction for the many families affected by autism across the country.

“OPM has closely monitored both the research supporting ABA and the provider supply which has increased in recent years. Our 2017 requirement reflects the needs of our members, the growing number of qualified providers who can safely and effectively offer ABA, as well as research linking behavioral interventions for children with ASD with positive outcomes,” Edmund Byrnes, a spokesman for the OPM, reported to Disability Scoop.

Lori Unumb, vice president of state government affairs at Autism Speaks comments on OPM’s progressive strides, “This is absolutely huge news for the autism community, we applaud OPM for stepping up to the plate and requiring ABA coverage for the 8 million people in Federal Employees Health Benefit plans.”

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