Essential health benefits (EHBs) provided by qualified health plans (QHPs) under the Affordable Care Act (ACA) are meant to cover rehabilitative and habilitative services. However, a new report by the American Occupational Therapy Association titled Analysis of Rehabilitation and Habilitation Benefits in Qualified Health Plans shows consumers lack information about those benefits. The report likewise reveals that many insurance carriers apparently are not complying with the standards for coverage of rehabilitative and habilitative services.

One of the report’s findings concluded that the most basic information about the rehabilitation benefits provided by QHPs is frequently absent or unclear. This applies to information about covered services and limitations on covered services. In fact, among more than half of QHPs none of the therapies the organizations cover appear under their rehabilitation and habilitation benefits, according to the report.

The AOTA report furthermore revealed that among some insurance carriers the presence of service limitations based on an individual’s age or health status on benefit designs suggest discrimination.

Chuck Willmarth, director of Health Policy and State Affairs for AOTA, says the report’s findings raise concern that there are nationwide issues regarding the information consumers receive about coverage and possible compliance issues with EHB benchmarks established for each state related to rehabilitation and habilitation.
“We hope to use the report to urge policymakers, insurance companies, and others to take a closer look at how these services are being covered and the information available to consumers as they make decisions about which plan to purchase on the exchange,” Willmarth says.
A media release from the AOTA states that many of the challenges identified in the report could likely be resolved through additional guidance, enhanced oversight, and increased diligence by insurance carriers.
Click here to read the complete report.
[Source: American Occupational Therapy Association]