State Medicaid plan managers can tinker with autism therapy and infertility treatment benefits but must meet federal mental health parity standards.
Officials at the Centers for Medicare & Medicaid Services (CMS) have given those instructions in a new batch of Patient Protection and Affordable Care (PPACA) regulations, "Essential Health Benefits in Alternative Benefit Plans, Eligibility Notices, Fair Hearing and Appeal Processes, and Premiums and Cost Sharing; Exchanges: Eligibility and Enrollment" (CMS-2334-F).
The PPACA EHB habilitative services provision could apply to users and providers of many different types of therapy, such as ordinary speech therapy for children who have trouble talking, or ordinary occupational therapy for children who have participating in class, but, in practice, the most active habilitative benefits battles have been over benefits for children with autism and related disorders.
Many parents of children with autism seek coverage for applied benefits analysis (ABA) therapy and other forms of intensive therapy that can cost more than $30,000 per year. The parents and their supporters contend that the money spent on the therapy can help some children who might end up spending their lives in institutions gain the ability to live on their own, work in the community and pay taxes.