Under the Patient Protection and Affordable Care Act, rehabilitation services is 1 of 10 essential benefit categories that are required to be offered under the Health Insurance Exchanges. The Department of Labor (DOL) has been working with the secretary of Health and Human Services (HHS) to provide data to aid in further determinations regarding each of these 12 essential benefits categories. Accordingly, physical therapy is 1 of 12 additional benefits included in a recent National Compensation Survey (NCS) conducted by DOL at the request of HHS. The survey supplements the medical benefit provisions regularly published as part of the NCS' employee benefits program.
DOL reports that physical therapy was mentioned in plan documents for 7 in 10 medical plan participants. In plans in which this benefit was mentioned, nearly all plan participants were covered. Covered participants were subject to both plan limits and separate limits for physical therapy. About half the participants subject to separate limits (29% out of 55%) were required to make a copayment per visit or therapy session. Copayments generally ranged from $10 to $40, and the median was $20.
About 1 in 3 participants (22% out of 69% with physical therapy coverage) in fee-for-service plans was required to make copayments, while the large majority of health maintenance organization participants (55% out of 72% that were covered) had a copayment requirement. Copayment amounts were similar between the 2 types of plans. A review of plan documents—not of national estimates created from the weighted plan data—revealed that many plans covering physical therapy limited the number of days or visits paid for per year. Common annual limits were 20, 30, or 60 days or visits. Less frequently observed were day or visit limits per illness or condition or maximum dollar amounts payable per year.
The results of the DOL survey will be considered along with the recommendations from the Institute of Medicine (IOM) on a process for defining and updating benefits. Beginning in the fall, HHS will launch an effort informed by IOM's recommendations to collect public comment on essential health benefits.