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  • With Health Care Reform Plan Still Unclear, APTA Signs Onto Coalition Letter to Preserve Rehab Services

    While Congress and the White House discuss what, if anything, will be offered as a replacement for or adjustment to the Affordable Care Act (ACA), APTA and other organizations are staking out their positions on policies that should remain no matter what. At the top of that list: ensuring access to care through the continuation of rehabilitation services and devices as an "essential health benefit" (EHB) that must be provided to patients.

    Recently, APTA joined a group of 46 national clinician, consumer, and membership organizations known as the Coalition to Preserve Rehabilitation (CPR) in a joint letter to Congress expressing opposition to any health care reform effort that would drop rehabilitation as an EHB for Medicaid expansion enrollees and would allow waivers so that states could create their own EHBs for ACA private plans (or eliminate EHBs completely). Both of those provisions, along with a third change that would allow states to waive requirements for community ratings to contain insurance costs—also opposed by CPR—were included in the American Health Care Act (AHCA) that was introduced and then withdrawn in the US House of Representatives.

    "There is little doubt under this scenario that access to rehabilitation services and devices would suffer in many areas of the country," CPR states in its letter. "Americans needing rehabilitation services and devices rely on their health care coverage plan to regain and/or maintain their maximum level of health, independent function, and independent living. This reduces long-term disability and dependency costs to society."

    The letter also urges Congress to maintain the skilled maintenance standard clarified by way of the Jimmo v Sibelius settlement that busted the myth of the "improvement standard."

    "CPR recommends that any legislation reforming the [ACA's] essential health benefits make explicitly clear that a patient need not demonstrate improvement in order for skilled services to be covered as reasonable and necessary," the statement says.

    This isn't APTA's first public statement on ACA reform. In late March, the association clearly laid out its opposition to the elimination of rehabilitation as an EHB, with APTA President Sharon Dunn, PT, PhD, writing that provisions being discussed at that time were "heading in a direction that would create unneeded barriers to care and reduce the access to care for millions of Americans." Ultimately, the plan on the table at that point was withdrawn without a vote. No substitute plan has emerged.

    According to Justin Elliott, APTA's vice president of government affairs, that doesn't mean APTA is sitting back to see what happens next.

    "The political situation on Capitol Hill with ACA continues to be very fluid," Elliott said. "Regardless, we will continue to reiterate our core messages to legislators and policymakers, and to educate them on why affordable access to rehabilitation services is really a cost-effective approach to health care, and one that protects a vulnerable population."

    And for members of CPR, the continuation of rehabilitative services will keep health care moving in the right direction.

    "The … members of CPR firmly believe that failing to replace the Affordable Care Act in a manner that would preserve access to rehabilitative services and devices would turn back the clock on children and adults with injuries, illnesses, disabilities, and chronic conditions," the statement concludes.

    Besides APTA, other members of CPR who signed onto the letter to Congress include the American Heart Association, the National Multiple Sclerosis Society, the Christopher and Dana Reeve Foundation, Disability Rights Education and Defense Fund, Paralyzed Veterans of America, United Cerebral Palsy, United Spinal Association, the Brain Injury Association of America, the Child Welfare League of America, and the Michael J. Fox Foundation for Parkinson’s Research.


    • Iam appreciative of APTA'S efforts to defend coverage for rehab services. As the details of the proposal are made clear, any proposed decrease in the number of covered lives overall must also be loudly opposed. I believe this position is clear in house policy and our vision. As a healthcare leader, we have to lead by example in the best interests of those we serve. Thank you APTA for all you do.

      Posted by James Dunleavy on 4/28/2017 9:41 AM

    • We must stop these cuts! Insurance companies/HMO's are out for profit and do not care for the skilled work Therapist's provide, as long as they meet a quota that earns them that profit. How do insurance companies/HMO's do this? By constantly changing policy and hiding these changes i.e. Changing a payment modifier for reimbursement, cutting reimbursment on specific codes, causing closure of clinics secondary to inability to pay for simple day to day operations, demanding therapists "grasp at straws" to explain: 'measures taken to address the reasons for lack of progress during authorized treatment periods' (basically stating therapist's theories of practice are not effective per insurance companies standards, yet insurance companies/HMO's don't provide treating therapists with policies or procedures of "their standards" and representatives of insurance companies/HMO's are furthermore trained not to provide that information), demanding standardized evaluations In a short time span among other tactics to create a 'lack of progress' to justify the denial for further treatments for clientel. Creating dichotomy among treating skilled Therapists (OT,PT,SLP) only approving one skilled service over another, not adhering to skilled professionals recommendations ie providing only once a month treatment vs recommended 2-3 times a week. This is atrocious conduct of the insurance/HMO's at the expense of the well being of our clientele, Therapists (OT,PT,SLPA), and clinics that provide these skilled health care services. We need to continue ralling and protesting this inappropriate behavior. Thank-You, Concerned Therapist, A.Parrish, MOTR/L

      Posted by AParrish on 4/28/2017 1:42 PM

    • Preserve PT as an EHB!!

      Posted by John Lockard on 4/28/2017 4:35 PM

    • I agree it is very disheartening how many healthcare policies are cutting funding for rehab services. It is wonderful that a patient can have surgery to resolve pain and dysfunction. However, rehab is equally important to restore functional mobility, improve quality of life, not to mention reducing the need for long term pain medication.

      Posted by Molly McDonald on 5/3/2017 4:44 PM

    • The benefit to not only patients but to insurances effective rehabilitation and patient outcomes is immeasurable.

      Posted by Dr. Tom Eggleton on 5/5/2017 6:30 PM

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