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
- When You Suspect Your Child May Have a Disability…
By Felicia Lebewohl Rosen, Esq., Ed.M. (Edited by Marion M. Walsh, Esq., Littman Krooks LLP) Take a deep breath … It can be emotionally difficult to accept and deal with the fact that your child has a disability. If you want your child with a disability to receive appropriate services to make his or her […]
- Liane Carter: Raising Children With Autism
Bernard A Krooks, Esq., and guest Liane Kupferberg Carter discuss raising children with autism on this podcast. Liane is a nationally-known writer and advocate for the autism community. She is the author of the new memoir, Ketchup is My Favorite Vegetable: A Family Grows Up with Autism (Jessica Kingsley Publishers).
- Every Student Succeeds Act Brings Incremental Shift and Changes
By Marion M. Walsh, Esq., Littman Krooks LLP By now, parents have heard the news. On December 10, 2015, President Obama signed the Every Student Succeeds Act (“ESSA”), which reauthorizes the Elementary and Secondary Education Act and replaces the No Child Left Behind Act of 2001 (“NCLB”). This represents a positive development for all students and […]
- New York Parent Advocates for Ability to Appeal Regents Score
By Sandi Rosenbaum, Educational Advocate, Littman Krooks LLP Although special education students in New York can pass their Regents exams with lower scores than students without disabilities, they do not have the same ability to appeal if they fall short. One New York parent, whose son was one point away from passing a Regents test, […]
- Transferring Guardianship When Moving to a New State
Guardianship can be an important legal tool to help family members care for a loved one who is unable to make his or her own decisions due to an illness or disability. Guardianship is determined in state court proceedings. However, when moving to another state, the question often arises whether it is necessary to transfer […]