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Affordable Care Act (ACA) and Autism

Synopsis of Law:
· Federal Health Care Reform and Autism Insurance

  • Prohibits discrimination in benefits against people with autism by including behavioral health treatments as part of the essential benefits package
  • Provides grants for mental and behavioral health education and training
  • Beginning 2014, health plans will include essential benefits package. The following is a list of items and services deemed essential:

-Ambulatory patient services
-Emergency services
-Maternity and newborn care
-Mental health and substance use disorder services, including behavioral health treatment
-Prescription drugs
-Rehabilitative and habilitative services and devices
-Laboratory services
-Preventive and wellness services and chronic disease management
-Pediatric services, including oral and vision care

  • Requires the following health plans to cover the list of essential benefits, including behavioral health treatment beginning in 2014:

-Plans offered by state-based exchanges, through which individuals and small businesses can purchase coverage
-Plans offered in the individual and small group markets outside the health insurance exchange

  • Does NOT require the following health insurance plans to provide essentials benefits package:

-Existing coverage
-Plans offered in the large group market outside exchanges
-Self-insured or ERISA plans

  • Law will help end neglectful practices such as:

-Pre-existing condition exclusions
-Excessive waiting periods for coverage
-Rescissions of coverage
-Limits ability of insurers to place annual and lifetime dollar caps on coverage

Registration for health plans under the Affordable Care Act begins October 1, 2013 and must be completed by March 1, 2014 to avoid a penalty. To learn about how the Affordable Care Act with effect autism insurance coverage in your state please visit our State Insurance Reform Initiatives Map. Each state’s information will detail whether or not ABA will be covered in that state under the Affordable Care Act and highlights information on past autism insurance reform, if applicable.

For more information visit the Affordable Care Act Fact Sheets

History of Federal Health Care Reform Law:

*On July 14, 2009 America’s Affordable Health Choices Act of 2009, or HR 3200, is introduced in the House.
*Congressman Mike Doyle introduces an amendment to include autism insurance reform to HR 3200 in the House Energy and Commerce Committee on July 16, 2009.
*The amendment is approved by the House Energy and Commerce Committee on July 31, 2009.
*HR 3590, or the Patient Protection and Affordable Car Act (PPACA), is introduced in the House of Representatives on September 17, 2009.
*Senator Robert Menendez’s autism insurance reform amendment to “America’s Healthy Future Act of 2009” is approved by the Senate Finance Committee on September 25, 2009.
*On October 8, 2009 the PPACA is voted out of the House.
*The Senate Finance Committee votes “America’s Healthy Future Act of 2009” out on October 13, 2009.
*HR 3200 is voted out of the House on November 7, 2009.
*The Senate passes PPACA with provisions for autism insurance reform on December 24, 2009.
*On March 17, 2010 HR 4872, or the Education Reconciliation Act of 2010, is introduced in the House. The House Concurs with Senate amendments to the PPACA and passes the companion bill HR 4872, which contains autism insurance reform as part of the essential benefits package.
*President Obama signs the Patient Protection and Affordable Care Act (P.L. 111-148) into law on March 23, 2010.
*The Senate passes HR 4872 on March 25, 2010. President Obama signs the Health Care and Education Reconciliation Act (P.L. 111-152) into law on March 30, 2011.

Federal Health Care Reform and Autism Insurance News:
SOURCE: Autism Votes - Federal Health Care Reform