LITTLE ROCK — After a month of “grueling” debate, insurance-exchange planners arrived Thursday at a tentative solution for the shape, the size and the scope of habilitative care in Arkansas.
Required for individual and small-group policies by the federal Affordable Care Act, 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.
Advocates for those in need pushed to expand the definition of services to include reinforcement activities that complement physical, speech or occupational therapies. An example would be teaching a child with cerebral palsy to eat with a fork and reinforcing the skill with daily sessions that complement traditionally covered therapies.
On Thursday, advocates and providers to the developmentally disabled got their wish as two planner committees signed off on a definition of services that includes the reinforcement therapies.
David Ivers, an attorney representing the Developmental Disability Providers Association, said advocates were satisfied with the broader scope of services, which was the key concern for them.
It’s less expensive and more widely available than just physical, occupational and speech therapies, which don’t fully address the needs of about 20,000 or so developmentally delayed children and adults, he said.
Planners also agreed to allow insurance carriers to set prices on and off the exchange for the services.
About 211,000 Arkansans are expected to enroll when the exchange begins taking customers in October. Insurance executives estimate that about 430,000 Arkansans would be affected by the inclusion of habilitative services as part of the state’s mandatory essential health benefit package for individuals and small businesses.
Insurers would also set up credentialing criteria for the providers.
Advocates said they accepted carriers having that kind of power, especially in a market previously unknown to private insurance. Currently, almost all developmental disability services are paid for by Medicaid.
“We’ll do whatever we can to help the carriers work out the pricing,” Ivers said.
The state Insurance Department would have regulatory authority to make sure that carriers are offering fair prices and structured plans. Insurance Commissioner Jay Bradford likely will recommend the plan to the federal government by Jan. 31.
Those actions appeared to calm previously worried insurance executives, concerned about the cost of achieving “parity” with rehabilitative care, as required by the new healthcare law.
Rough estimates presented on Thursday by Sam Partin, an Arkansas Blue Cross and Blue Shield senior vice president, showed an average monthly premium increase per member of $4 if parity was calculated by costs. If parity were to be determined by the number of visits allowed by year, monthly premiums would rise by about $8.
Advocates said those estimates were too high and assumed too many people would be interested in private coverage for habilitative care.
Former state Supreme Court Justice Annabelle Imber Tuck made a connection between the concerns of the month-long debate over how to cover habilitative care and what happened with flood insurance. The federal government took over insuring against floods because private insurers couldn’t accurately assess the damage caused by floods, she said.
“Why are we having such trouble with this?” Tuck asked. “The same has happened with habilitative services because the government has gotten into the ballgame, primarily through Medicaid. It really is a new ballgame for the private carriers. We really shouldn’t berate ourselves for going through three meetings - we needed information,” Tuck said.
State Surgeon General Dr. Joe Thompson complimented members of the Plan Management and Steering Committee (of which he’s a member) on their hard work, characterizing the debate as “grueling.”
Ivers told planners that he thought the successful solution to a thorny problem showed the strength of a state partnership with the federal government.
Arkansas and Delaware are the only states so far to receive federal approval for the hybrid state-federal model. Republican state lawmakers are increasingly discussing legislation to force the state to scrap the partnership and in favor of an exchange completely controlled at the federal level.
Such a change would remove state involvement from consumer assistance and outreach efforts. A federal exchange would also end the Insurance Department’s role in evaluating and regulating plans on the exchange.
“I think we’ve shown that there really is a difference,” Ivers said, praising the partnership model.
Arkansas, Pages 9 on 01/25/2013