LITTLE ROCK — Three times wasn’t the charm for state health insurance exchange planners and developmental disability advocates Friday.
Disagreements over costs and questions about how many people even want private coverage for habilitative services delayed action by planners for a third time since December.
Former state Supreme Court Justice Annabelle Imber Tuck, co-chairman of the Plan Management Committee, sounded an exasperated note at the end of Friday’s meeting.
“I realize we can extend it out ad infinitum,” Tuck said. “But I think we need to put it to bed.”
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 want to expand the definition of services to include reinforcement activities that complement physical, speech or occupational therapies.
For example, teaching a child with cerebral palsy to eat with a fork and reinforcing the skill with daily sessions that complement traditionally covered therapies.
Developmental disability advocates want the state to guarantee children receive those reinforcement activities. Initially, exchange planners restricted such services to more-traditional physical, speech and occupational therapies.
Insurance companies are leery of potential costs because they’ve never covered the reinforcement activities, making actuarial estimates difficult. And habilitative services don’t have a definite end; they may last throughout a lifetime.
Advocates say most of the population under discussion are children, now covered by Medicaid, some of whom catch up to peers during childhood and stop needing extra help.
Unclear definitions and a lack of evidence-based studies on the effectiveness of such services complicate insurers’ task, said Vic Snyder, former Democratic congressman in the 2nd District and now Arkansas Blue Cross, Blue Shield’s corporate medical director for external affairs.
“There so much fogginess about the definitions,” Snyder said. “How do we go to [our actuaries] and say we need you to score social, emotional and self-help adaptive skills.”
Medicaid coverage is likely to be cheaper and more extensive than anything offered by private insurers, raising the question of how many families would need or want private coverage.
Few people would consider leaving Medicaid coverage for private insurance, said David Ivers, an attorney representing the Developmental Disability Providers Association, especially if insurance companies set a cap that’s too low for the number of reinforcement activity visits.
Under the Affordable Care Act, individual and groups of up to 100 people have to be offered habilitative services “on par” with rehabilitative services. Large plans don’t have to offer the benefit.
Ivers said providers and advocates are worried that as Medicaid and the state exchanges seek to streamline their benefits and make them more compatible for people who “churn” between the two systems through job loss, illness or other maladies, watered-down habilitative care standards in the exchange might eventually weaken the strong benefits currently enjoyed by Medicaid recipients.
“That’s one concern,” he said after the meeting.
The committee agreed to meet again Thursday to examine more data to determine how many people in the exchange would need habilitative services and make a final recommendation to the exchange’s steering committee. Insurance Commissioner Jay Bradford will make the final call.
The state’s exchange planners have already asked the federal government for an extension on a decision until the end of January, said Cynthia Crone, the exchange’s planning director.
Conceivably, Washington could allow the state even more time, she said, but insurers need to know the parameters of what habilitative care entails by early February so they can develop plans for the exchange, which begins enrollment Oct. 1.
Coverage begins in January 2014. About 211,000 Arkansans are expected to be eligible for exchange coverage.
Arkansas, Pages 15 on 01/20/2013