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.