The Affordable Care Act was among the most discussed news stories of 2013. Much of the reporting centered on the many frustrations and problems caused by its halting implementation. Merging health insurance with federal law is bound to result in complicated text, and the ACA is all that one would expect in this regard. Amid all the noise and confusion lie some gems that we can celebrate, such as the inclusion of habilitation services as part of the newly required package of health insurance benefits.
Habilitation is the provision of services that help individuals with developmental disabilities improve, maintain and prevent deterioration of functioning. In the past, most health insurance policies did not include these kinds of services and defined them as educational rather than health-related issues. Through the diligent efforts of consumer advocate groups and professional groups, such as the American Occupational Therapy Association, habilitation services have been added as a basic, covered health service.
According to the American Academy of Physical Medicine and Rehabilitation’s position paper “Defining ‘Rehabilitative and Habilitative Services and Devices,’” the ACA requires insurance to routinely cover:
• Therapies that improve, maintain and prevent deterioration of function, including pain management.
• Therapies or treatments that enable people with developmental disabilities to attain functional abilities or reduce the deterioration of function over time.
• Outpatient rehabilitation services without an arbitrary cap on benefits that is unrelated to medical necessity, and maintenance services (to prevent deterioration), cognitive retraining, adaptive skills training and other services as determined by a physician to be reasonable and necessary.
• Durable medical equipment, prosthetics, orthotics, mobility equipment, supplies, and assistive and adaptive devices that improve or maintain function and do not include arbitrary limits on access to these devices and related services.
These changes are nothing short of revolutionary. Can you imagine what it will be like to provide OT under these less restrictive rules? I’d love to hear what you imagine doing, given such freedom!
Of course, the road to implementation of the ACA will continue to involve challenges and resistance, as have all social reforms. Each state will interpret the law independently, and there will no doubt be many voices on all sides of the issues. We can expect debates and legal challenges. It will behoove us and those we serve to keep up with events as they evolve, and to continue to advocate assertively when and where it counts.
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