How The Affordable Care Act May Affect Those With Developmental Disabilities
White Plains, NY (Law Firm Newswire) February 28, 2013 - The Affordable Care Act (ACA) has a provision that expands coverage of certain treatments for autism, cerebral palsy and other developmental disabilities, but a lack of specificity in the law means that it can still be difficult to pin insurers down on exactly what will be covered.
Policies purchased on the new health insurance exchanges are required by law to cover ten essential health benefits. Among these are “rehabilitative and habilitative services and devices.” This revision is beneficial for people with developmental disabilities; many insurance policies did not previously cover habilitative services.
The new coverage comes from a revised understanding of the distinction between rehabilitative and habilitative services. Rehabilitative services, such as physical or occupational therapy after a stroke or accident, may help people recover functional ability. These services have traditionally been covered under many health insurance policies. Habilitative services may be very similar to them, but, by definition, they help people (including people with developmental disabilities) to learn or maintain functions that were never lost. Insurance policies often denied coverage for such services, arguing that they fell under education issues and were not medically necessary.
Now, insurance policies purchased under the new exchanges must provide these services. Other insurance policies, including large employer group plans, are not subject to the new requirements, but a ripple effect may cause insurers to bring those plans in line with ACA rules eventually.
However, advocates for people with disabilities are still disappointed with the lack of clear coverage definitions. Rather than spell the coverage requirements out, the Department of Health and Human Services is allowing states and insurance companies to decide. States may define habilitative services themselves, require insurance policies to cover those services on “parity” with rehabilitative services or let insurers decide how to provide each benefit. Unfortunately, this system causes a lot of uncertainty for individuals attempting to find out whether specific habilitative services will be covered by a particular plan.
One service that is particularly important to people with autism is behavioral therapy (specifically, applied behavior analysis or ABA treatment). This is one of the treatments that may or may not be included in state determinations of what is required. Fortunately, according to the nonprofit Autism Speaks, ABA coverage has been specifically mandated by 18 states, including New York.
About Littman Krooks LLP
Littman Krooks provides sophisticated legal advice and the high level of expertise ordinarily associated with large law firms along with the personal attention and responsiveness of smaller firms. These ingredients, which are the cornerstone of effective representation and are necessary to a successful lawyer/client relationship, have become the foundation of the firm’s success.
Littman Krooks LLP offers legal services in several areas of law, including elder law, estate planning, special needs planning, special education advocacy, and corporate and securities. Their offices are located at 655 Third Avenue, New York, New York; 399 Knollwood Road, White Plains, New York; and 300 Westage Business Center Drive, Fishkill, New York. Visit the firm’s website at www.littmankrooks.com.
Was this article of interest to you? If so, please LIKE our Facebook Page by clicking here.
New York Contact:
Maria M. Brill
Littman Krooks LLP
New York City Office
655 Third Avenue, 20th Floor
New York, New York 10017
(212) 490-2020 Phone
399 Knollwood Road
White Plains, New York 10603
(914) 684-2100 Phone
300 Westage Business Center Drive, Suite 400
Fishkill, NY 12524
(845) 896-1106 Phone
View Larger Map
- WIHD LEND Program Recruiting Family Specialist Trainees
The Westchester Institute for Human Development (WIHD) is recruiting leadership trainees for its Leadership Education in Neurodevelopmental and Related Disabilities (LEND) training program. Trainees will have the opportunity to develop the skills necessary for a career focused on helping children with special needs and their families. The program includes three overview courses, clinical experience, and […]
- Special Needs Expos
Earlier this year, we interviewed Heather Rogoff Angstreich, Founder/Partner, Special Needs Expos about the upcoming year and events they are holding in 2015. Here’s what she had to say: Why did you create special needs expos? All I wanted to do was help other parents and children who were in my shoes. My son, (who is […]
- Community Based Service Network To Serve Medicaid Beneficiaries in Westchester County
The Neighborhood Network of New York (NNNY) is set to develop an innovative, community based service network for adults with autism, thanks to a grant from the New York State Office for People with Developmental Disabilities (OPWDD). The program will provide individualized services to clients, including remote support technology and community activities. NNNY will launch […]
- Special Education Waiver Proposal Threatens Student Services
By Marion Walsh, Esq. and Sandi Rosenbaum, Special Education Advocate On March 4, 2015, between 6:30-8:00, the Lower Hudson Valley Special Education Advocacy Task Force will be holding a Policy Discussion Forum at the Arc of Westchester (The Gleeson-Israel Gateway Center, 265 Saw Mill River Road (9A), Hawthorne, NY), to discuss the Executive Budget and the […]
- Wandering and Autism: Wearable QR Codes
By Erin Wilson, Founder, If I Need Help.org Last year, New Yorkers rallied to change laws regarding school safety and making tracking devices available to vulnerable people. According to Autism Wandering Awareness Alerts Response and Education (AWAARE), a 2011 study conducted by the Interactive Autism Network through the Kennedy Krieger Institute found that: Roughly half, […]