The Department of Health and Human Services has issued its final Rule defining required "essential health benefits" under the Affordable Care Act. Download FINAL RULE.HHS.ESSENTIAL HEALTH BENEFITS.022113 Early reporting is not so certain about what it includes.
It is apparently certain that the final Rule includes something called "Mental Health" Coverage as an Essential Health Benefit. "Essential health benefits" is a shorthand description of what every Policy and Plan subject to the ACA is supposed to include, unless exempted. It is apparently less certain what this actually means. In other words, it is apparently unclear what the new Rule means in its reference to "Mental Health" Coverage. In particular, it may not be known for some time whether and to what degree Coverage for Autism is going to be a required Essential Health Benefit in future Health Insurance Policies and Plans. See Robert Pear, "New Federal Rule Requires Insurers to Offer Mental Health Coverage" p. A15, col. 1 (New York Times Nat'l ed., Thursday, February 21, 2013).
One way to search out the place of Autism in the complex regulatory world spawned by the ACA is to ask advocates. "Autism Speaks, an advocacy group, said so far only half the states planned to include the therapy [referring to an unidentified therapy for Autism]." See Jennifer Corbett Dooren, "Health Law Gets New Clarity" p. A2, col. 1 (Wall Street Journal, Thursday, February 21, 2013)(subscription required to read the full article online). Compare Wall Street Journal, supra, with New York Times, supra (in which the senior policy analyst at the same Autism Speaks is cited as authority for the statement that 32 States have laws requiring Coverage of Autism treatments).
As we move forward implementing the new final Rule, along with the rest of the ACA's provisions, Rules, and Regulations, it will become more clear whether Essential Health Benefits include treatment for Autism and exactly what Essential Health Benefits treatment of Mental Health actually involves. We will keep checking in, and we will share the results of our searches with you here.
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