Excerpt from HAB: (click for entire article)
Habilitative and rehabilitative services and devices are mandated as essential health benefits (“EHB”) in Section 1302 of the Patient Protection and Affordable Care Act (ACA), Pub. L. 111-148. It is critical that the regulations on the EHB package explicitly establish appropriate coverage of these benefits in a manner that is consistent with the intent of the statute and the needs of people with disabilities and other conditions that require habilitation services and devices.
In setting the EHB package, the Institute of Medicine (IOM) recently recommended that the HHS Secretary start with the benefit package of the typical small employer plan, add to it benefits listed in the ten categories of the law not otherwise covered by the small employer plan, including habilitation services and devices, and then balance that package against the nondiscrimination protections and an actuarial analysis to limit costs. In deciding which specific benefits to include under habilitation, the IOM recommended that the Secretary look to the Medicaid program as a guide.
The HAB Coalition supports this approach and further recommends that the HHS Secretary seriously consider the definition of habilitation services and devices developed by the National Association of Insurance Commissioners (NAIC). This definition, along with consideration of the types of habilitation services that Medicaid covers, would serve as a sound foundation on which to align a habilitation coverage standard under the EHB package. The HAB Coalition recommends that, once the foundation is laid, HHS continue to assess coverage of habilitation services and devices to ensure that children and adults are able to access the habilitation services and devices they need.