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
In this mostly helpful Q&A where a reader inquires about coverage of therapy services when a patient's needs are significant, there is need for clarification. This is a valuable illustration of a media report that undoubtedly had the best intention of informing its readers, but nonetheless includes a statement that could easily be misinterpreted.
The reader's question demonstrates confusion regarding different insurance market reforms included in the Affordable Care Act (ACA). The ACA prevents insurance companies from excluding coverage of services based on a beneficiary's pre-existing condition. It also requires certain health plans to cover certain benefits, known as essential health benefits (more on that in previous blog posts here and here). Where the article stumbles is where it states, "Insurers cannot limit coverage for any of the essential benefits." What the author likely meant to convey is that the ACA prohibits insurers from imposing lifetime or annual dollar limits on essential health benefits. In other words, an insurer's health plan that is subject to the ACA's requirements (some plans are exempt), and must cover occupational therapy as an essential health benefit, cannot impose a $500 a year limit, or a $5,000 lifetime limit, on coverage of occupational therapy services (those dollar amounts are arbitrarily selected to illustrate the point). The ACA's essential health benefit requirements, as they currently exist, do not prevent an insurer from imposing visit limits on therapy services. Nor does the ACA prevent insurers from establishing other limits on therapy services, such as pre-authorization requirements. As the article describes, the limits can vary from state to state, and potentially from plan to plan. While occupational therapy is an essential health benefit in almost every state, and therefore coverage of occupational therapy services should be included in almost all health plans subject to the essential health benefit requirements, in most cases therapy services will be subject to some sort of limits.
The article taken as a whole is fairly clear and accurate, but with the ACA being as complicated as it is, every sentence describing it needs to be precise in order to avoid confusion, and the quote above is lacking in that regard.