A federal judge’s Dec.14 ruling that the Affordable Care Act (ACA) is unconstitutional and its provisions(such as essential health benefits and pre-existing condition protections) are invalid, complicates a regulatory scenario that already threatens consumers’access to habilitation and rehabilitation services.
The judge did not,however, enjoin the law—meaning that the ACA is still the law. Whether this decision is ultimately upheld depends on the outcome of what is likely to be a lengthy appeals process that could end up at the U.S. Supreme Court.
But habilitation and rehabilitation coverage is already threatened. The Centers for Medicare and Medicaid Services (CMS) issued regulations that give states greater flexibility in defining essential health benefits (EHBs) beginning in 2020 (see “ACA Plans May Reduce Therapy Coverage”) and allowing states to adjust the list of ACA-covered health care services. Changing coverage levels for habilitation and rehabilitation especially affect access to audiology and speech-language pathology services and devices.
(Note: The ACA is a federal law, but states have the ability to implement and regulate it.)
Historically, health insurers have covered rehabilitation, so payers understand that rehab helps a person re-establish lost or impaired skills. However, habilitation—a newer, less familiar benefit—helps a person establish skills they have not acquired at an age-appropriate level. Because the concept is newer, states may be more likely to reduce or even remove habilitation coverage from ACA health plans.
Preserving habilitation and rehabilitation services and devices as EHBs under the ACA is a top priority in ASHA’s 2019 Public Policy Agenda. ASHA developed the Speech,Language, and Hearing Services: Essential Coverage of Habilitation and Rehabilitation as part of an Advocacy Toolkit for members and state associations advocating for habilitation. Advocates can use the toolkit—talking points and fact sheet, a step-by-step advocacy plan, and a sample template letter for state decision-makers—when they speak with state insurance commissioners, regulators and legislators.
As part of the advocacy effort, ASHA has recruited members in each state to coordinate local habilitation advocacy efforts. The following states have not yet designated a habilitation advocate: Alabama, Arizona, Arkansas, Colorado, District of Columbia, Florida, Idaho, Indiana, Iowa, Kansas, Maine, Maryland, Michigan, Missouri,Nebraska, New Hampshire, New York, North Carolina, North Dakota, Oregon, Rhode Island, South Dakota, Utah, Virginia, Washington, Wisconsin and Wyoming.
If you live in one of these states and are interested in becoming a habilitation advocate, contact Daneen Sekoni, ASHA’s Director of Health Care Reform, at firstname.lastname@example.org. Audiologists and SLPs in states considering changes to habilitation and rehabilitation coverage can email email@example.com guidance and support.
Daneen Sekoni, MHSA, is director of ASHA health care reform policy. firstname.lastname@example.org