The ASHA Leader - February 2015 - 24

p o L i c y a n a Ly S i S

Proposed Rule Mandates Coverage
of Habilitation Services
If the rule becomes final, health plans would be required to provide speech-language and other
services to people across the range of ages and disabilities.
By Tim NaNof aNd daNeeN Grooms

Speech-language pathology is
included in the definition of
"habilitation services" in proposed
2016 federal regulations for health
plans under the Affordable Care Act.
If included in the final rule, these
provisions would broaden access
to speech-language treatment-
particularly for children and for
people of all ages with developmental
disabilities-and open the door to
continued advocacy for improved
audiology coverage.
The ACA requires health plans
to offer a set of essential health
benefits that include rehabilitative
and habilitative services and devices.
The proposed rule, published by the
Centers for Medicare and Medicaid
Services in November 2014,
creates a nationwide definition for
habilitative services that explicitly
lists speech-language pathology,
occupational therapy and physical
therapy as examples of services
covered in both categories. It also
creates the opportunity for coverage
of additional services, including
rehabilitative and habilitative
audiology and related devices.
The habilitation definition
was crafted in 2010 by the
National Association of Insurance
Commissioners with significant
ASHA input and support (on.
asha.org/aca-defs). ASHA initially
proposed the definition to the
NAIC committee that established a
glossary of terms designed to inform
consumers about health plan details.
It defines habilitative services as:
Health care services that help a
person keep, learn or improve skills
and functioning for daily living.
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February 2015 |

THe aSHa Le aDer

Examples include therapy for a child
who isn't walking or talking at the
expected age. These services may
include physical and occupational
therapy, speech-language pathology
and other services for people with
disabilities in a variety of inpatient
and/or outpatient settings.
Rehabilitative services differ in
that they help a person regain skills
and functioning lost to illness or
trauma.

Why a national definition?

Under current policy, states are
allowed to define the habilitative
benefit-and if they don't, individual
health plans can choose how to
provide habilitation coverage. Many
states have not defined habilitation
and many plans, therefore, opted to

restrict coverage to a narrow list of
specific conditions and a narrow list
of treatments.
If the rule becomes final as
written, it would establish this
definition as a national standard that
states and health plans must meet.
In addition, a national standard
provides leverage for continued
advocacy. With a national
mandate in hand, national and
local professional and consumer
associations, as well as individual
clinicians and patients, can
reference federal definitions and
requirements when advocating with
state regulators and health plan
administrators on the coverage of
audiology and speech-language
pathology services in health care
exchanges (see sidebar, page 26).

http://on.asha.org/aca-defs http://on.asha.org/aca-defs

The ASHA Leader - February 2015

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