The Patient Protection and Affordable Care Act, often referred to simply as the ACA or Obamacare, was signed into law on March 23, 2010. The ACA is intended to expand access to health insurance coverage for millions of uninsured Americans by expanding eligibility for Medicaid and developing health insurance marketplaces where uninsured persons may be eligible for subsidies to make private health plans more affordable. While expanding access to health insurance is a big part of the ACA, there are many other purposes of the law, including provisions intended to reform the health care delivery system to produce better patient outcomes at lower cost.
AOTA was very active in the legislative process leading up to the passage and signing of the ACA, working to achieve victories such as inclusion of rehabilitation and habilitation in the essential health benefits package. AOTA has also been monitorting the regulatory process at the federal and state levels as the ACA has been implemented, and has been advocating for occupational therapy practitioners and consumers. The dynamic environment created by health care reform creates opportunities, but vigilant monitoring of implementation activities and carefully executed advocacy efforts are necessary to ensure occupational therapy is valued and protected in the future.
Please also see the Health Care Reform Implementation page on AOTA's website at: http://www.aota.org/Advocacy-Policy/Health-Care-Reform.aspx
Previously I wrote about the importance of the Affordable Care Act's new requirement to cover habilitative services as essential health benefits. It's a unique opportunity for OT practitioners to provide services that have often been denied by insurance companies in the past, and likewise for OT consumers to receive those services. Despite advocacy from AOTA, state OT associations, and their allies, the regulations developed to implement this requirement of the law at the federal and state levels do not provide all the protections we'd like to see for consumers and providers. While some states like Colorado, Maryland, Washington State, and West Virginia have adopted coverage requirements for habilitative services that are favorable, other states' requirements and the federal requirements that are in effect in states that did not take regulatory action, leave us with some concerns that need to be addressed during future advocacy efforts.
I was interviewed by a reporter at Stateline (the daily news service of the Pew Charitable Trusts) about the habilitation benefit and AOTA's perspective on the way it has been implemented. The article conveyed some of our key concerns including the following.
1. Rehabilitative and habilitative services, both included in the essential health benefit requirements, should be treated as distinct benefits.
2. Maintenance services should be included in the rehabilitative and habilitative benefits to ensure functional progress achieved is not lost.
3. Adequate information about rehabilitation and habilitation is not currently available for consumers to make informed choices when selecting health plans on the exchanges.
Furthermore, the article provided a fairly good description of what habilitative services are, which is important in and of itself, as many people are not familiar with the concept, in addition to not knowing the ACA requires certain plans cover these services. The Stateline article was published by a variety of other news outlets, including USA Today.
AOTA will be working to educate OT practitioners and consumers about the requirements related to habilitative services, as well as what to look for when selecting a health plan. In addition, AOTA will be partnering with state OT associations and other allied organizations to advocate for improvements in coverage of habilitative OT services, as the federal regulations currently governing the habilitation benefit are expected to be revisited as early as next year.