Tool from AOTA, APTA, and ASHA helps evaluate habilitative and rehabilitative insurance benefits
Use this resource to assess benefit designs in public and private insurance and make the case for appropriate coverage of therapy services with insurers, employers, and policymakers.
Joint habilitation/rehabilitation benefit coverage statement: Guide to assessing adequacy of benefits
Habilitative and rehabilitative services and devices are essential parts of comprehensive health insurance, and occupational therapy, physical therapy, and speech therapy are the foundational services in any habilitation and rehabilitation benefits package. AOTA, the American Physical Therapy Association (APTA), and the American Speech-Language-Hearing Association (ASHA) have created a checklist of things to consider when evaluating rehabilitation and habilitation benefit designs.
How to define habilitation and rehabilitation
Habilitative services help a person keep, learn, or improve skills or functioning for daily living. In contrast, rehabilitative services help a person keep, get back, or improve skills and functioning for daily living that have been lost or impaired because of being sick, hurt, or disabled.
By promoting these definitions of habilitation and rehabilitation, we are advancing the principle that therapy benefits should include services to attain and maintain, not just regain, skills and functioning.
What else to look for
The checklist also addresses:
- breadth of services,
- cost-sharing levels,
- consumer information,
- utilization management practices,
- whether benefits meet the needs of vulnerable groups.
Read the tool for evaluating hab and rehab benefits.
Related resources
Advocating for occupational therapy coverage within ACA Marketplaces
A new AOTA report analyzes how rehabilitation and habilitation services are covered in ACA Marketplace plans.
Analysis of rehabilitation and habilitation in ACA plans
Research from AOTA examines how ACA Marketplace plans cover the Essential Health Benefits (EHB) category of rehabilitative and habilitative services and devices.