Ill-Defined Coverage Muddles Insurance For Developmentally Disabled

[Demeter]

Source: NPR



A little remarked upon requirement in the federal 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 mandate....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 , a professor of health law and policy at George Washington University who authored 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," she says.

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Read more: http://www.npr.org/blogs/health/2014/01/14/262385922/ill-defined-coverage-muddles-insurance-for-developmentally-disabled?ft=1&f=1001

[jwirr]

1. Then they should still cover them as preventatives. If a person with a DD does not recieve these

services their health often deteriorates. For instance PT - muscles atrophy and no longer work. That goes for the mind also. If they are not doing something they will eventually end up in more intensive care units and all of these are more expensive. If these insurers want to pay for nursing home care instead of less expensive care they are taking the right steps to do so.

As to not recovering function? I have seen many clients who came out of the institutions who gained a great deal of function where they were not expected to do so. My daughter had a 30 years life expectancy when she was born - because of the medical and others services she has she is now 58 years old and still pretty healthy. Here we have another one of those death panels the rethugs want so bad.

Edited to say that if you notice it is the insurers not ACA that is doing this.