The elimination or weakening of EHBs has a direct impact on the level of service you're able to provide to patients.
EHBs are a package of benefits that ensure that certain health plans offered in the state Health Insurance Exchanges provide a baseline of coverage, benefits, and services to their enrollees. Currently, benefits including rehabilitative and habilitative services and devices, preventive and wellness services, maternity care, and ambulatory patient services are considered EHBs. It's crucial that these benefits be maintained—and even expanded.
Unfortunately, states can impose visit limits, caps, or other restrictions for therapy services. And a 2020 update to the Affordable Care Act actually loosened requirements on how states can configure the "benchmark" plans that effectively establish a minimum benefit package, to the detriment of patients.
Why It Matters
The elimination or weakening of EHBs has a direct impact on the level of service you're able to provide to patients. When health plans are permitted to offer more limited coverage, or even no coverage, for services such as habilitation and rehabilitation, patient access to needed physical therapy deteriorates and health care outcomes are impacted. Robust EHBs allow you to deliver the professional services you were trained to deliver, in ways that make a difference in patients' lives.
As advocates of societal health, APTA believes all these benefits should remain essential, reinforced with the adoption in 2018 of the House of Delegates position APTA Statement in Support of Essential Health Benefits. However, of particular interest to the profession is the rehabilitative and habilitative services and devices benefit.
Aug 30, 2018 / Policies & Bylaws
House position: Statement on APTA supporting the inclusion of a defined package of essential health benefits in all insurance plans to ensure individuals have adequate access to comprehensive health services that meet their unique needs.
Feb 10, 2021 / Resource
APTA, AOTA, and ASHA developed a resource for public and private insurers, employers, and consumers to evaluate the appropriateness of rehabilitation and habilitation benefit design.
Additional Essential Health Benefits Advocacy Content
Feb 8, 2023 / News
The association's public policy priorities are aimed at unleashing physical therapy's potential to take on pressing health care challenges.
Jul 1, 2019 / Feature
Health is affected by far more than the presence or absence of health care. PTs and PTAs can help improve the health of populations by using a wide array of strategies.
Feb 19, 2019 / Comment Letters
EHBs are a package of benefits that ensure that certain health plans offered in the state Health Insurance Exchanges provide a baseline of coverage, benefits, and services to their enrollees.
Nov 1, 2017 / Column
Here's what PTs need to know, and why it's important.