Habilitation – What it is And Why it Matters to You

Most of us are familiar with the term rehabilitation and are comfortable with our role in providing “rehab” services.  Habilitation, on the other hand, may be less common. I don’t know of many SLPs who consider themselves “habilitation providers.” Audiologists may be somewhat more comfortable with the term as providers of aural habilitation, but not in other contexts.

So, what is habilitation? Basically, we are talking about services that help a person learn, keep, or improve skills and functional abilities that they may not be developing normally. Still not clear? Contrast that with services that help a person improve skills that have been lost after a stroke, head injury, illness, or other cause. The latter is rehabilitation – regaining lost skills or functioning. Habilitation refers to services for those who may not have ever developed the skill, such as a child who is not talking as expected for his or her age.  Adults can also benefit from habilitative services, particularly those with intellectual disabilities or disorders such as cerebral palsy who may benefit from services at different points in their life to address functional abilities.

Why the focus on distinguishing habilitation from rehabilitation? Anyone who has dealt with private insurance for a person needing habilitative services likely knows the answer. If you look closely at coverage descriptions for many insurance plans, you’ll likely see language specifying that services like physical therapy or speech-language pathology will be provided when skills have been lost due to illness or injury. This language automatically restricts payment for services to those who haven’t had a stroke or suffered an illness, including most children who don’t have a specific diagnosis underlying their speech, language, swallowing, or hearing problems.

Habilitation is getting national attention right now due to the implementation of the health care reform law. Part of the law stipulates that insurance plans offered through the state exchanges and Medicaid programs must provide services in 10 categories of essential health benefits (EHBs), including the category of rehabilitation and habilitation services and devices. ASHA has been anxiously awaiting the regulations regarding the EHBs and has been working particularly hard on ensuring adequate coverage for habilitative services through the Habilitation Benefits Coalition. The concern centers primarily on the fact that habilitative services are not common in “typical” employer plans, upon which the EHBs are to be based, and this lack of clarity around what habilitative services are and how they should be covered could result in continued difficulty with reimbursement for these services.

Recently, the Department of Health and Human Services (HHS) issued the Essential Health Benefits Bulletin in lieu of regulations. This bulletin is offered as guidance, but does not have the power of a regulation. Essentially, the bulletin gives the states the responsibility of determining EHBs, allowing for greater flexibility and customization to each state’s unique needs. Some highlights from this bulletin include:

  • States will have flexibility in choosing their benchmark plan and will have to supplement that plan with any of the EHB categories that are lacking
  • Plans cannot discriminate based on age, disability or life expectancy, but no specific guidance on this is offered
  • If a state doesn’t choose a plan, the default plan will be the largest small group plan based on enrollment
  • States will have to submit their choices to HHS for approval
  • Self-insured group health plans, large group plans, and grandfathered plans will not be required to cover essential health benefits at this time
  • Comments on the pre-rule bulletin are being accepted until January 31, 2012

When addressing habilitation specifically in the bulletin, HHS acknowledges that these services are less well-defined and that confusion exists over what exactly is covered by such a benefit. They have proposed two options for situations where the state chosen benchmark plan does not include habilitation. These include:

  1. Habilitative services would be offered at parity with rehabilitative services — a plan covering services such as PT, OT, and ST for rehabilitation must also cover those services in similar scope, amount, and duration for habilitation; or
  2. As a transitional approach, plans would decide which habilitative services to cover, and would report on that coverage to HHS. HHS would evaluate those decisions, and further define habilitative services in the future (p. 11)

As one can see, the issue of appropriate coverage for both rehabilitation and habilitation services is going to come down to state-level debates and decisions. ASHA will continue to monitor developments and take action, when appropriate, but the burden of the work will likely fall to the state associations and members within each state. If this issue resonates with you, we encourage you to contact your State Advocate for Reimbursement (STAR) and state association to assist in any advocacy efforts. Individuals requiring speech and hearing services, regardless of etiology, have a right to services to help them function as independently as possible. We have a tremendous opportunity now to ensure appropriate coverage for habilitative services as an essential health benefit. This is your chance to have a real impact on the future of health care.

Amy Hasselkus, M.A., CCC-SLP, is associate director of health care services in speech-language pathology at ASHA. She is also currently enrolled in a Masters degree program in communication at George Mason University, with an emphasis on health communication.

Not all Health Information on the Web is Created Equally

modern chair with attached computer monitor

Photo by Mads Boedker

In addition to being a speech-language pathologist, I am also working towards a Master’s degree in communication. My specific area of interest is health communication, which I came to rather naturally as my work at ASHA evolved. Part of what I do is develop content for brochures and other consumer materials, including what exists on the ASHA website. In the beginning, I approached this from my SLP background and clinical experience and described clinical disorders and other topics from that perspective. Over time, I started to realize that what I developed, while not wrong, was likely missing the mark in terms of what the reader wanted. I came to this realization after stumbling across information about health literacy, which led me to research on the readability of consumer materials developed by health professionals and organizations, including ASHA.

I also learned about how people use the Internet to search for health information and how the information they often find is difficult to understand or does not address their specific questions. I stepped back and took a more critical look at the information that existed in ASHA materials and on the website and found that there was room for improvement. And I’m happy to report that ASHA has spent a number of years now working on making those improvements, which hopefully some of you have noticed in products like consumer brochures and the Let’s Talk: Patient Education Handouts, as well as on the public side of ASHA’s website (for those of you who haven’t yet seen the recently updated information about hearing and hearing loss on ASHA’s public site, I invite you to take a look).

This semester I am taking a class on eHealth Communication, which focuses on the theory and practice of communicating health information via electronic means. We recently had a discussion about health related web pages and how they are “hit or miss” in terms of being understandable, valid, and meaningful. We talked about how the average web user may not always know whether a site is “good” or filled with misinformation. We had many questions, such as can people easily figure out if the content was developed by a credible source or guided by those with a financial interest in the decisions readers might make from what they read on the site? Are they able to make decisions based upon what they read (or see and hear if video and audio are included on the site)? Do they find information that means something to them or is it too generic or complex to have any real value?

Coincidentally, the day after this discussion, the leader of ASHA’s wellness team posted an article from the New York Times talking about this very issue. The article compared and contrasted two well-known health web sites – WebMD and the Mayo Clinic – and talked about the content, the design, and the motivations behind the two sites. The class discussion and the article got me thinking – how do I assess the sites I go to? I definitely look at the number and type of ads and I try to figure out who authored the information. I also look at how it is written and will only delve into really complex, technical content if I am highly motivated about the topic. Because of my background and personal interest in health communication, I may be more critical of the writing style, use of terminology, and layout than most, but I do consider that when deciding if I want to spend any time on a site.

So now I ask you – what factors do you consider when determining if you are going to spend time on a site? Do you suggest sites for your patients? How do you decide which ones are the most appropriate? Do you ever follow-up to see if they found the site or found it useful? The Internet is full of information and not all of it is good. Knowing that many people search the web for health information, it really seems that it is our professional responsibility to help guide our patients as best we can. And maybe we can learn something ourselves along the way.

Amy Hasselkus, M.A., CCC-SLP, is associate director of health care services in speech-language pathology at ASHA. She is also currently enrolled in a Masters degree program in communication at George Mason University, with an emphasis on health communication.

Patient-Provider Communication

How well do you communicate with your clients? We are, after all, experts in human communication. Shouldn’t that mean that we are good at communicating with the people we serve?

Words and letters


Photo by Chrissy Johnson1

Unfortunately, this may not always be the case. Like many other health care providers, SLPs and audiologists often have trouble communicating clearly so that clients fully understand and can use the information we share. We tend to use jargon and talk in medical or technical terms that are not easily understood by the average person. We use words like “dysarthria” or “sensorineural.” We talk about a person’s “standard scores,” “functional abilities,” and degree of hearing loss in terms of “decibels.” We also tend to share written information that is very dense and complex and do so without spending time explaining the information we’ve given out. This has been demonstrated in studies of the readability of communication disorder-related brochures as well as reflected in responses to ASHA surveys about how consumer materials are used.

Patient-provider communication is a hot topic these days. Do an Internet search of the term “patient provider communication” and you’ll find resources from the Institute for Healthcare Improvement, the American Medical Association, scholarly journals, and more. Go to the Joint Commission website and you’ll find new standards regarding effective, culturally competent patient communication. Closer to home, a group interested parties, including a number of ASHA members, have joined together and formed the Patient-Provider Communication Forum in an attempt to further patient-provider communication across the continuum of care. Patient-provider communication, including issues related to health literacy, is fast becoming as serious an issue in health care as universal precautions. In fact, the Agency for Healthcare Research and Quality (AHRQ) has branded its information about health literacy as a universal precaution. Makes sense if you consider that poor communication can result in very harmful consequences and poor outcomes if medical advice is not understood and followed.

So, how do you think you do in regards to communicating with your clients? Do you think they understand what you are telling them? Do they appear to read brochures and other information you give them? And, more importantly, do you think they understand that information well enough to follow through on any recommendations in it? What do you do to try to improve your communication with clients and families? As experts in human communication, we can lead the charge on effective patient-provider communication. But first we need to be good at it ourselves.

Amy Hasselkus, M.A., CCC-SLP, is associate director of health care services in speech-language pathology at ASHA. She is also currently enrolled in a Masters degree program in communication at George Mason University, with an emphasis on health communication.