Health Law Adds Coverage For Developmental Disability Services
By Michelle Andrews, Kaiser Health News
January 14, 2014
A little remarked upon requirement in the health law expands treatments for people with cerebral palsy, autism and other developmental disabilities. But some advocates and policy experts are concerned that insurers may find ways to sidestep the new requirement.
The health law requires that individual and small group plans sold on or off the health insurance marketplaces cover 10 essential health benefits, including “rehabilitative and habilitative services and devices.”
Health plans of all kinds typically cover rehabilitative services, such as physical, occupational and speech therapy to help people who had an accident or illness, such as a stroke, recover their ability to walk, talk and function in their daily lives. But before the health law passed, coverage of similar services for habilitative purposes — that is, to help people learn or maintain functional skills, rather than regain them — was often excluded.
Insurers would “say they’re not medically necessary,” says Sara Rosenbaum, a professor of health law and policy at George Washington University who authored a recent paper about the law’s habilitative coverage requirements. “They’d say patients are not recovering function, but rather developing function, and that was an education issue.”
http://www.disabilityscoop.com/2014/01/14/health-adds-coverage/19016/
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