Mandatory Coverage of Autism Treatment Could Affect FEHBP Premiums

Insurance carriers have to submit their 2017 benefit and rate proposals to OPM by May 31.

It’s not yet clear how new mandatory coverage of a popular therapy for autistic kids will affect premiums next year in the Federal Employees Health Benefits Program, according to the Office of Personnel Management.

“Carriers may or may not propose a premium increase to cover this benefit, depending upon their estimates of the costs and likely utilization of the benefit,” said an OPM question-and-answer document on Applied Behavior Analysis coverage. “Some plans already provide the benefit and their premiums will be unaffected.”

Beginning in 2017, all insurance carriers participating in FEHBP must cover ABA, a popular treatment for children with some form of autism. ABA has been clinically proven to help increase an autistic child’s I.Q., language abilities and coping skills. On Thursday, Acting OPM Director Beth Cobert said that until now, FEHBP coverage “has been uneven for this intense one-on-one therapy that is becoming a leading form of treatment for these children.”

Cobert, who spoke at the annual FEHBP program carrier conference Thursday morning in Arlington, Va., said OPM has “continued to receive letters from federal families desperate to get this coverage for their children,” despite the agency having encouraged FEHB insurance carriers since 2013 to provide the treatment. “We heard from federal families who had to pay out-of-pocket for this expensive treatment just because of where they lived.”

Government Executive first reported in February that all FEHBP insurance carriers must provide ABA coverage as a medical treatment beginning next year. “We have reached a tipping point: if we are to assure that federal employees are treated consistently across the country -- and that our carriers are to compete fairly in the FEHB market -- it is necessary to require this coverage for all carriers,” stated the OPM document on the ABA change.

The FEHBP carrier conference, jointly sponsored by OPM and America’s Health Insurance Plans, planned to devote a session Thursday to discussing Applied Behavior Analysis and the coverage changes. Most of the conference, held at the Renaissance Arlington Capital View hotel, was closed to the press. Reporters were only allowed in for Cobert's 30-minute speech Thursday morning.

FEHBP carriers have to submit their 2017 benefit and rate proposals by May 31. OPM expects to have benefit and rate negotiations for next year finished by mid-August. In 2016, overall premiums for non-postal employees and annuitants, including all enrollment options and both the employee and government portions, increased by 6.4 percent. That increase was double that of the 2015 bump, and the largest since 2011. The jump was the first in five years to surpass 4 percent.

Still, OPM officials have argued that FEHBP is a good deal for federal employees, and have described the increases as relatively modest.

Cobert on Thursday also mentioned the 19 performance measures OPM will use to assess carriers. “This year we are particularly zeroing in on three important priority items – blood pressure control, the timeliness of prenatal care, and reducing hospital readmissions,” she said.

On cybersecurity, OPM will send guidance soon to FEHBP carriers “regarding the reporting of information security incidents,” Cobert said.