The federal Affordable Care Act is said to be nearly 11,000 pages long. For all that verbiage, covering so many issues, there is one particular section that advocates for individuals with developmental disabilities say is sadly lacking in detail. And their fear is that it could wind up hurting those they are dedicated to helping.
The issue centers on an ACA provision that requires that plans offered through the health care exchange markets include coverage for "rehabilitative and habilitative services and devices." The problem, according to the advocates, is that there is no clear definition of what is meant by habilitative services.
In general, health insurance plans have long offered coverage for things like physical, speech and occupational therapies when prescribed for rehabilitative reasons. That is, if a person becomes impaired due to accident or illness, insurance will pay.
The same has not been necessarily true for those with developmental disabilities. Conditions like cerebral palsy or autism, may allow a person to receive Social Security disability benefits, but insurance companies have often denied coverage for functional therapies, declaring them as not medically necessary. The theory is that such treatments teach new skills to these individuals, rather than restore old ones. That makes such services an educational issue.
The intent of the provision clearly seems to be that rehabilitative and habilitative therapies should be treated equally. But what actually gets covered as habilitative treatment is left up to the individual states and the insurers who offer plans through the exchange. And according to one assessment by advocates, fewer than half the states have clearly designated what habilitative coverage should be.
What this story reinforces is just how complicated the law can be. Where there is uncertainty, knowing your rights and fighting for them can be difficult. Where questions exist, it's always best to consult with an experienced attorney.
Source: Disability Scoop, "Health Law Adds Coverage For Developmental Disability Services," Michelle Andrews, Kaiser Health News, Jan. 14, 2014