Federal Documents Clarify Rehabilitation and Habilitation Services New federal documents designed to help consumers choosing health plan coverage define habilitation services and rehabilitation services and call attention to whether a health plan limits the number of visits covered for each. The Patient Protection and Affordable Care Act of 2010 requires health plans to provide a brief summary ... News in Brief
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News in Brief  |   July 01, 2016
Federal Documents Clarify Rehabilitation and Habilitation Services
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Regulatory, Legislative & Advocacy / ASHA News & Member Stories / News in Brief
News in Brief   |   July 01, 2016
Federal Documents Clarify Rehabilitation and Habilitation Services
The ASHA Leader, July 2016, Vol. 21, 11. doi:10.1044/leader.NIB3.21072016.11
The ASHA Leader, July 2016, Vol. 21, 11. doi:10.1044/leader.NIB3.21072016.11
New federal documents designed to help consumers choosing health plan coverage define habilitation services and rehabilitation services and call attention to whether a health plan limits the number of visits covered for each.
The Patient Protection and Affordable Care Act of 2010 requires health plans to provide a brief summary of what the plan covers and what the consumer’s out-of-pocket costs will be, so that consumers can make informed choices. Plans also must provide a comprehensive uniform glossary of commonly used health coverage and medical terms.
Released in April by the Centers for Medicare and Medicaid Services (CMS), the guidance includes two documents:
All health plans must use the template for enrollment years that begin after April 1, 2017. In response to advocacy from stakeholders, including ASHA, the template requires health plans to note any limitations on the number of allowable speech-language visits and to list those limits separately for habilitation and rehabilitation services.
The glossary includes the following definitions:
  • Habilitation services: Health care services that help a person keep, learn or improve skills and functioning for daily living. Examples include therapy for a child who isn’t walking or talking at the expected age. These services may include physical and occupational therapy, speech-language pathology and other services for people with disabilities in a variety of inpatient and/or outpatient settings.

  • Rehabilitation services: Health care services that help a person keep, get back, or improve skills and functioning for daily living that have been lost or impaired because a person was sick, hurt or disabled. These services may include physical and occupational therapy, speech-language pathology and psychiatric rehabilitation services in a variety of inpatient and/or outpatient settings.

  • Medically necessary: Health care services or supplies needed to prevent, diagnose or treat an illness, injury, condition, disease or its symptoms, including habilitation, and that meet accepted standards of medicine.

For more information, contact Daneen Grooms, ASHA director of health reform analysis and advocacy, dgrooms@asha.org or 301-296-5651.
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July 2016
Volume 21, Issue 7