Eli's Rehab Report

Published on Thu Jul 26, 2012 PDF

Supreme Court decision pushes Affordable Care Act full-throttle.

June 28, 2012 marked a historic day when the U.S. Supreme Court upheld the Affordable Care Act. Exactly how the ACA will affect your daily rehab operations, however, remains nebulous. The Department of Health and

Human Services, along with the Centers for Medicare and Medicaid Services still must create pages of instructions, rules, and transmittals on executing this new law.

"It is difficult to say with any degree of certainty how the Supreme Court's decision upholding the ACA will impact rehabilitation service providers, especially considering that some implementation efforts will not begin in earnest until after elections this November," notes Jennifer Hitchon, regulatory counsel for the American Occupational Therapy Administration.

What we do know: "A number of ACA provisions directly and positively impact therapy, including provisions on guaranteed issue, prohibitions against rescission, family coverage for adult children up to age 26, and payment for quality over quantity," Hitchon says.

The American Physical Therapy Association remains officially neutral on the ACA. APTA says it will continue to focus on the same issues for which it has always advocated: quality care, access, outcomes, patient education, payment reform, etc.

"We will continue to work with legislators, policy makers, insurers and other decision makers to ensure that these priorities are addressed in this law and future health care reforms -- whether at the national or state level, or through individual private payment systems," said APTA President Paul Rockar Jr., PT, DPT, MS, in a statement.

Lucky for SLPs: The ACA includes several pilot projects to make healthcare more efficient, particularly for telehealth. "We feel that speech language pathology has proven to be very effective through telehealth services," says Mark Kander, director of health care regulatory analysis for the American Speech-Language Hearing Association.

Keep an Eye on Medicaid

The Supreme Court ruled that the states could choose to not enroll thousands of citizens who otherwise would be insured through the Medicaid programs -- which will create a "large impact," Kander notes.

"The states are in such bad shape that they're trying to avoid any extra expense," Kander observes. "This Medicaid ruling means that there are a lot of citizens who do not have to have insurance, and we may continue to see people go to ERs and hospitals while the rest of the citizens pay for those uninsured people."

Rehab Inclusion a Double-Edged Sword

The ACA includes "rehabilitation and habilitation services" as required essential health benefits offered by plans operating in state-based purchasing exchanges, Hitchon points out. On the plus side, "Once the law is fully implemented, practitioners should see a reduced number of coverage denials based on insurance company determinations that a service is 'habilitative,'" she says.

Be alert: Even with mandatory rehab services in most Qualified Health Plans, "states will most likely impose annual visit limits, caps, or other restrictions for therapy services as current employer-sponsored plans do," predicts APTA in its online bulletin, News Now.