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Showing posts from September 13, 2015

How the New Rule on #Habilitative Services Affects Children with Special Needs

The federal government issued a new rule in February regarding the Essential Health Benefits (EHBs) that must be included in all individual and small-group health plans sold in or outside of ACA Exchanges.  This rule may lead to improved “habilitative” services for children with disabilities.  Habilitative services are “Health care services that help you keep, learn, or improve skills and functioning for daily living.” (Seehttps://www.healthcare.gov/glossary/habilitative-habilitation-services/.)  For children with special needs, this could include services such as speech, physical, and occupational therapies. 
What changed? Under the previous regulations, insurers could define habilitative services themselves if the state benchmark plan did not include those services and the state did not establish its own definition.  Under the new rule, effective for plans beginning in 2016, there will be a federal definition of habilitative services,[i] which will apply if the state benchmark plan d…