AOTA Files Comments on Medicaid Proposed Rule
AOTA submitted a comment letter on February 21, 2013 to the Centers for Medicare & Medicaid Services (CMS) on its proposed Medicaid rule. The rule is long and complex and addresses a variety of issues related to the Affordable Care Act’s expansion of Medicaid eligibility, but the key issue it addresses that impacts the profession of occupational therapy is related to the definition of habilitative services.
The newly eligible Medicaid population, in states that decide to expand eligibility, must receive Medicaid coverage that includes all of the Essential Health Benefits required by the Affordable Care Act. One of those benefits is coverage of habilitative services. However, that service category remains undefined in the proposed Medicaid rule, except that CMS has proposed that each state define the habilitative benefit. CMS posed several questions to stakeholders regarding what parameters should be placed on states related to this delegation of authority.
AOTA has worked, and continues to work with state occupational therapy associations to produce definitions of habilitative services for the private insurance market that are as favorable to the profession and its clients as possible. However, AOTA has documented a variety of inadequate definitions of habilitative services that have been adopted in some states. In an effort to avoid a similar outcome for the Medicaid expansion population, AOTA and its partners submitted comments to CMS on the proposed Medicaid rule requesting certain minimum parameters be established to ensure definitions of habilitative services provide adequate coverage to Medicaid beneficiaries.
The following are the minimum standards we requested. The full letter may be read below, as well as a coalition letter that AOTA signed onto.
Coverage of habilitative services should be distinct from coverage of rehabilitative services.
Coverage should not be limited by age or medical condition.
Coverage requirements should explicitly mention the three core therapy services recognized by the National Association of Insurance Commissioners (NAIC), i.e., occupational therapy, physical therapy, and speech-language pathology.
The definition should be consistent with the NAIC definition and the existing Medicaid definition and include coverage for acquisition, retention, and improvement of function.
There should be no exclusion for services that may be educationally-relevant, as is the current policy in Medicaid.
Availability of habilitative benefits should be based on determinations of need instead of arbitrary limits, but if quantitative limits are imposed, they should be separate from and at least at parity with those for rehabilitative services.
AOTA comment letter on Medicaid proposed rule
Habilitation Benefits Coalition comment letter on Medicaid proposed rule