Employers are required to cover rehabilitative services as part of their health care coverage, but it’s really not as complicated as it sounds. If you’re an applicable large employer, then your business must offer health care that covers the 10 essential health benefits; that includes rehabilitation. All health plans offered by the marketplace exchange, along with nonmarketplace qualified plans, already provide this coverage.
What Are Rehabilitative Services and Devices?
The American Academy of Physical Medicine and Rehabilitation (AAPMR) helps define rehabilitation in terms of its part in the ACA-mandated essential health care benefits. Specifically, it covers all areas of rehabilitation, including care needed immediately after an operation, outpatient rehabilitation therapy such as physical therapy or pain management, and intensive in-patient therapy in a hospital. These services are meant to restore abilities that were lost and minimize physical or mental limitations.
Typically, an accident, injury or medical condition robs people of abilities that they used to have, and rehabilitation is used to help restore those skills. Rehabilitation can also help people adapt to chronic conditions and prevent abilities from deteriorating further. For example, a child who has cerebral palsy may need rehabilitation to keep him from losing the ability to use his arm, or someone with Parkinson’s may need rehabilitation to help slow down loss of function.
Rehabilitative devices aid in this treatment. They might include prosthetics (artificial legs, for example), orthotics (such as neck braces) or wheelchairs. Prosthetics can also include devices that replace the function of an internal organ that’s no longer working correctly.
How Are Habilitative Services and Devices Different?
The AAPMR refers to habilitation as ongoing, medically necessary therapy for developmentally disabled children. While rehabilitation refers to treatment for people who need therapy to get them back to the physical state they were in before, habilitation implies helping children gain functions or skills they never had.
Why Are These Services Important?
The Affordable Care Act made these services an essential health benefit so that insurance plans couldn’t deny coverage simply because the treatment may not cure the disease. For example, for someone with a chronic illness, rehabilitation might help him reach a plateau and slow deterioration, even if the disease itself isn’t cured. With traumatic brain injuries, it may take time to see results, but consistent therapy is needed every day to keep the patient from losing even more skills. Rehabilitative services can also speed recovery and lead to better outcomes for patients, improve long-term health and reduce the likelihood of relapse. For your employees, these services might mean the difference between someone having to quit their job or stay on long-term disability versus being able to return to work.
Essentially, if you’re an applicable large employer offering an ACA-qualified health care plan to your workforce, then you’re already covering rehabilitation services. If you don’t offer ACA-compliant plans, you might face hefty fines unless your plan was grandfathered in. Of course, if you want to help retain employees or attract new top talent, you might consider adding supplemental insurance options such as more physical therapy visits or in-office preventive- and wellness-driven sessions.
This content is provided solely for informational purposes. It is not intended as and does not constitute legal advice. The information contained herein should not be relied upon or used as a substitute for consultation with legal, accounting, tax and/or other professional advisers.
Stephanie Dwilson has extensive experience providing expertise on topics including health, law and marketing. She’s a science journalist published by Fox News, a marketing expert and an attorney with expertise in personal injury law. She’s also a small business expert featured by Businessweek and Millionaire Blueprints magazine and has worked as a marketing consultant for ministries and as a PR lead for one of the largest churches in America.