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.

Our Position

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.