Health exchange’s planners delay move on long-term care

— Insurance-exchange planners wrestled again Friday with provisions in the Affordable Care Act requiring “habilitative” care to be offered on the state’s exchange, and delayed a recommendation on the matter for a week to determine how many people are likely to seek coverage and the cost of providing their care.

At Friday’s meeting of the exchange’s Plan Management Committee, Co-Chairman Annabelle Imber Tuck, a former state Supreme Court justice, said that analyzing the issue more before an end-of-the-month deadline was a better option than to “punt” the problem back to the federal Department of Health and Human Services as other states have done.

“Better late than never,” she said.

Habilitative services are often long-term therapies and other forms of aid that help developmentally delayed or disabled people gain skills for daily living - and maintain them.

The new federal healthcare law requires that habilitative services be offered by insurance companies.

Private insurers don’t offer coverage for the services now; Medicaid provides the bulk of coverage.

Most of the newly eligible population under the law will be children, as developmentally disabled adults often are unable to work and qualify for Medicaid.

For children, some of the services include lessons in crawling, eating, dressing or toilet training.

As part of the state’s essential health benefit, habilitative services have to be made available to individuals and small groups of up to 100 people in the regular insurance market, as well.

Developmental-disability providers, who serve more than 20,000 children and adults in Arkansas, have lobbied exchange planners to expand the scope of services from an initial recommendation that limits benefits to speech, physical and occupational therapy.

Planners have largely agreed that a more expansive menu of treatment should be made available, but insurers remain concerned about the cost and how therapists will be vetted and monitored.

The association of developmentally disabled providers has proposed that habilitative services be performed only in clinics licensed by the state Department of Human Services to avoid fly-by-night opportunists from flooding the market - a “Joe’s Habilitative Shack,” as described by David Ivers, an attorney for the association.

But some committee members balked at limiting providers in what is essentially a new health-care market.

“I’m concerned about a monopoly,” said C. Edward Anderson, chief financial officer at the Johnson Regional Medical Center in Clarksville.

Currently, the state has 85 centers. The Department of Human Services won’t issue new licenses except for “under served” areas.

Derrick Smith, a lawyer with Mitchell, Williams, Selig, Gates and Woodyard, said he wanted more information about the potential costs of habilitative care.

Tuck agreed and proposed that the committee gather information about costs. The committee agreed to meet again next Friday.

The exchange asked the federal government for an extension on its habilitative care guidelines last month after providers and exchange planners couldn’t agree.

Cynthia Crone, the exchange’s planning director, said the state must have something concrete for the federal government by the end of January.

She also asked committee members to educate the public about their work.

A “myth getting louder every day,” Crone said, is the claim that there is no difference between the state’s choice of a partnership with the federal government on the exchange and an exchange operated completely by that government.

Under a partnership model, the state retains more control over handling consumer complaints and deciding which plans will be offered, among other functions, state officials have said.

Republican state lawmakers have increasingly questioned the partnership model in recent weeks. In 2011, the Legislature squelched a state-run exchange, prompting Gov. Mike Beebe to order the state to pursue a partnership model.

About 211,000 Arkansans, many of them currently uninsured, are expected to be eligible to buy policies on the exchange. Federal subsidies will be available to those making up to 400 percent of the poverty line, or $92,200 for a family of four.

Enrollment begins in October and coverage in January 2014. People will be able to shop for policies online or with the help of “guides” who will be hired in the coming months to fan out across the state and educate the public about the exchange.

Front Section, Pages 1 on 01/12/2013

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