The ASHA Leader - February 2015 - (Page 26)

p o L i C y A n A Ly S i S Despite this language, previous regulations and guidance had no enforceable standards to ensure that health plans implemented it. Together, the definition and the nondiscrimination rules would help to ensure that beneficiaries receive needed services for medical conditions and functional impairments-regardless of the underlying causes. A long road Initial versions of the ACA legislation did not include rehabilitation/ habilitation services and devices as essential health benefits, covering them under the broader hospitalization and ambulatory care category, with little chance for consistent coverage. Through the Consortium for Citizens With Disabilities, ASHA worked with the American Physical Therapy Association, the American The definition and the nondiscrimination rules ensure that beneficiaries receive services for medical conditions and functional impairments-regardless of the underlying causes. Occupational Therapy Association and a host of other groups to press Congress to include rehabilitation/ habilitation as essential health benefits. As part of this advocacy effort, ASHA founded the Habilitation Coalition, bringing together more than 30 national associations. ASHA worked independently and with the coalition, and secured ASHA representation on the NAIC workgroup that created the definition in the proposed rule. But including rehabilitation/ habilitation services as one of 10 essential health benefit categories in Health Insurance Exchanges The Affordable Care Act mandates the creation of federal- and state-run health insurance exchanges (or marketplaces), where consumers can shop for health insurance coverage in person with the help of enrollment navigators or, more commonly, online. There are several types of exchanges, and states have options in structuring and establishing exchanges. They must, however, have an exchange operating within the state, even if they choose not to operate it. Each exchange has a minimum set of benefits (established in a benchmark plan) that all qualified plans must offer. The variation among exchanges is related to how the benchmark plans are chosen and how beneficiaries enroll. The options include: * State-based exchange: States perform all exchange functions, including establishing benchmark plans, determining coverage options and enrolling beneficiaries. * State-partnership exchange: States provide some consumer assistance, but the U.S. Department of Health and Human Services performs the remaining functions. Consumers enroll through healthcare.gov. * Federally supported state-based exchange: States perform all exchange functions, but use a federal website structure. Consumers enroll through healthcare.gov. * Federally facilitated exchange: The U.S. Department of Health and Human Services performs all functions and consumers enroll through healthcare.gov. the ACA was just the first-albeit critical-step. Unlike the other nine categories, habilitation/rehabilitation services lacked specific benefit and coverage information. There was no federal guidance because the rules for implementing ACA plans were based on those of private health plans-and private plan coverage of habilitation was extremely rare. Many plans limited coverage to only children with autism and only one treatment-applied behavior analysis. ASHA and the Habilitation Coalition argued that these types of limits did not meet the requirements of the statute or create a meaningful essential health benefit, and worked with federal agencies to create rules that would require states and health plans to meet the ACA obligations. The proposed regulation is only the beginning; ASHA continues to work to ensure that the final rule includes all of these important provisions and that states and health plans interpret and implement them appropriately. The final rule is expected in the spring. For updates on the status of essential health benefits and other policy information, follow ASHA Advocacy on Facebook (www. facebook.com/AshaAdvocacy) or sign up to receive Headlines policy e-mails (send a blank e-mail with the subject "subscribe to Headlines" to emailsupport@asha.org). Tim Nanof, MSW, is director of ASHA health care policy and advocacy. tnanof@asha.org · Daneen Grooms, MHSA, is director of ASHA health reform analysis and advocacy. dgrooms@asha.org · 26 FEbrUAry 2015 | THE ASHA LE ADEr http://www.facebook.com/AshaAdvocacy http://www.facebook.com/AshaAdvocacy http://www.healthcare.gov http://www.healthcare.gov http://www.healthcare.gov

The ASHA Leader - February 2015

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