How The Affordable Care Act May Affect Those With Developmental Disabilities | Law Firm Newswire

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
(914) 684-2100
[email protected]

New York City Office
655 Third Avenue, 20th Floor
New York, New York 10017
(212) 490-2020 Phone

Westchester Office
399 Knollwood Road
White Plains, New York 10603
(914) 684-2100 Phone

Dutchess Office
300 Westage Business Center Drive, Suite 400
Fishkill, NY 12524
(845) 896-1106 Phone


View Larger Map

  • Parents Face a Complex System When Searching for Services for Children With Special Needs
    <p>Obtaining services for a child with special needs has never been an easy or straightforward process. However, given the realities that the country is currently facing, parents with children who have special needs are having an especially difficult time obtaining the services their children need to thrive. Parents are experts when it comes to their […]</p>
    <p>The post <a href="https://www.specialneedsnewyork.com/2020/11/parents-face-a-complex-system-when-searching-for-services-for-children-with-special-needs/" target="_blank">Parents Face a Complex System When Searching for Services for Children With Special Needs</a> first appeared on <a href="https://www.specialneedsnewyork.com/" target="_blank">Littman Krooks, LLP</a>.</p>
  • Tips for Parents on How to Adapt to a Special Education Remote-Learning Environment
    <p>For many families, one of the most challenging aspects of the pandemic has been ensuring that their children continue to receive the education they need. This has especially been the case for parents of children with disabilities. Initially, many service providers closed due to the stay-at-home orders. Since these facilities have started to reopen, staff, […]</p>
    <p>The post <a href="https://www.specialneedsnewyork.com/2020/10/tips-for-parents-on-how-to-adapt-to-a-special-education-remote-learning-environment/" target="_blank">Tips for Parents on How to Adapt to a Special Education Remote-Learning Environment</a> first appeared on <a href="https://www.specialneedsnewyork.com/" target="_blank">Littman Krooks, LLP</a>.</p>
  • Obtaining Services for Children with Special Needs During the Pandemic
    <p>Studies show that approximately 90 percent of a child’s brain development occurs before the age of five. For children with learning disabilities or other special needs, these early years are crucial. Early intervention, sometimes even before a child has a diagnosis, can be extremely effective. As one special education expert explained, “If you miss that […]</p>
    <p>The post <a href="https://www.specialneedsnewyork.com/2020/09/the-challenges-of-obtaining-services-for-children-with-special-needs-in-the-wake-of-the-covid-19-pandemic/" target="_blank">Obtaining Services for Children with Special Needs During the Pandemic</a> first appeared on <a href="https://www.specialneedsnewyork.com/" target="_blank">Littman Krooks, LLP</a>.</p>
  • Parents of Students with IEPs Raise Concerns Over Regression in Light of COVID-Related School Closures 
    <p>The COVID-19 pandemic has affected every New Yorker. Parents of children who have an individualized education program (IEP) are facing unique challenges, as school closures have resulted in an unavailability of services for many families. Indeed, services disappeared overnight for thousands of New York students, leaving parents to figure out how best to get their […]</p>
    <p>The post <a href="https://www.specialneedsnewyork.com/2020/07/parents-of-students-with-ieps-raise-concerns-over-regression-in-light-of-covid-related-school-closures/" target="_blank">Parents of Students with IEPs Raise Concerns Over Regression in Light of COVID-Related School Closures </a> first appeared on <a href="https://www.specialneedsnewyork.com/" target="_blank">Littman Krooks, LLP</a>.</p>
  • Why We Sponsor NAMIWalks Westchester
    <p>By Marion M. Walsh, Esq., Littman Krooks LLP We applaud the work of NAMI Westchester, as our work at Littman Krooks LLP is aligned to their mission in helping individuals with mental health concerns. Here are some of the reasons we sponsor NAMI Westchester’s annual walk: NAMI Westchester works to end the pervasive stigma that […]</p>
    <p>The post <a href="https://www.specialneedsnewyork.com/2020/05/why-we-sponsor-namiwalks-westchester/" target="_blank">Why We Sponsor NAMIWalks Westchester</a> first appeared on <a href="https://www.specialneedsnewyork.com/" target="_blank">Littman Krooks, LLP</a>.</p>

Tags: , , , , ,



Get headlines from Law Firm Newswire sent right to your inbox.

* indicates required