Understand the Importance to ALL THERAPISTS of the “Essential Health Benefits” Clause in the Affordable Care Act

The Affordable Care Act requires that everyone in the United States have health insurance beginning in 2014. To facilitate this, the law also calls
for the establishment of state run health insurance purchasing “exchanges” to help improve insurance access, choice, cost, and coverage. Qualified insurance plans participating in these exchanges are required to cover, at a minimum, a package of “essential health benefits,” . The national professional organizations for all three disciplines ( APTA, AOTA, and ASHA have worked very hard to  help  ensure that rehabilitation and habilitation were included, meaning that they are trying to ensure that there will be insurance coverage for PT OT and ST services.  Because this will be implemented state by state, it is important for you to keep an eye on what your state is up to on the law’s implementation, because this can have far reaching positive implications for your practice and your patients beginning in 2014, regardless of whether you are an in or out of network provider, have an insurance or cash based practice.   The AOTA has put together a great chart on all 50 states so you can see what your state is doing so far. Check it out!


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