There's been no shortage of news coverage on the problems users of the health insurance exchange websites have been experiencing, particularly with those being run by the federal government. While the initial reports suggested the cause may be the volume of visitors to the sites (reportedly in the millions), time has revealed that the problems run deeper than that. I recently attended two national conferences where this topic was repeatedly discussed.

At the National Academy of State Health Policy's (NASHP) annual conference, which is largely attended by state agency officials who work on health policy and the advocates who lobby them, the tone was relatively optimistic. In general, the expectation was that state-run exchanges will and are running relatively well, and the federally-facilitated exchanges will eventually be functioning properly, even if it takes months. There were frequent references to the challenges faced when creating similar, albeit less complicated systems in the past, like that created for Medicare Part D. In that case, there were significant problems and delays, but ultimately the system was made to work and consumers are now quite pleased with it.

In contrast, at the America's Health Insurance Plans (AHIP) state-issues conference, which is largely attended by employees and advocates for health insurance carriers, the discussion was notably more critical. While some of the speakers one might see at NASHP's conference were fairly optimistic, those who represented the perspective of health plans focused on the problems. For example, many carriers are either not receiving information about who has enrolled in their plans, or they are receiving what appears to be inaccurate information. Furthermore, in most cases, the number of actual enrollees in specific plans, as opposed to people who have applied but not yet enrolled, is very low.

For more on the challenges related to the health insurance exchanges, see this previous post.

Both conferences included much more than discussions about the status of health insurance exchanges. NASHP's conference had a session titled Mental Health Parity and Habilitation: Defining Essential Health Benefits. Defining habilitation is a key issue AOTA has focused on to ensure OT is a core component of the benefit in all 50 states. The most interesting points were raised by an official from Arkansas's Insurance Department. Arkansas is one of the states that chose to define habilitation, and Arkansas's Occupational Therapy Association participated in public meetings where the definition was developed. While the state already adopted a definition that is quite good (e.g., it specifically mentions OT as a covered service and includes coverage of maintenance services), Arkansas is unique in that it is considering how to define habilitation at parity with both outpatient and inpatient rehabilitation. Most states that have defined habilitation by requiring that coverage be at parity with coverage of rehabilitation have only considered outpatient rehabilitation. While the specifics are still being developed, it seems likely that more generous coverage of habilitative services may be required as a result.

Also at the session on habilitation, an official from Washington State's Office of the Insurance Commissioner made a very important point about the essential health benefit requirements. Regulators will be doing their best to ensure health plans comply with the requirements, but ultimately enforcement of many aspects of the law will be complaint-driven. It is critical for OT practitioners to be aware of the new requirements related to coverage of OT services in their states, so that they can help to identify potential violations that warrant complaints.

At AHIP's conference, there was also some discussion of the essential health benefit requirements. Of most relevance, a panelist (coincidentally a NASHP staff member), reminded everyone that the federal regulations governing the essential health benefits were intended to apply only on an interim basis. Therefore, it is expected that the U.S. Department of Health & Human Services will revisit those requirements, which creates a new opportunity for advocacy, particularly as it relates to the requirements for habilitation coverage.

For more thoughts and observations from NASHP and AHIP, check out my Twitter feed (NASHP was Oct. 9-11 and AHIP was Oct. 17-18).