Insurers' habilitation and rehabilitation benefits come in all shapes and sizes—which is exactly the problem, according to APTA, the American Occupational Therapy Association (AOTA), and the American-Speech-Language-Hearing Association (ASHA). That's why the 3 organizations collaborated on a guide to assessing benefit adequacy that emphasizes transparency, access, and affordability throughout benefit plans that can be all over the map.

The guide forgoes offering a laundry list of specific benefits in favor of establishing a set of principles that the associations believe lead to appropriate coverage of habilitative and rehabilitative services. Those principles are rooted in the idea that the benefits are necessary not just to improve function but also to maintain it, and that physical therapy, occupational therapy, and speech-language pathology are the "key" services in any habilitation/rehabilitation benefit package. The collaborative document echoes many of the themes included in APTA's public policy priorities, which emphasize increased patient access, cost and coverage transparency, and use of telehealth in service delivery.

The resource addresses how best to ensure adequate scope of coverage and access, appropriate provider qualifications, and essential benefit information needed for consumers to determine if a plan meets their needs. It also provides tips and recommendations for consumers as well as plan providers and policymakers.

However, the guide isn't just a collection of broad statements—APTA, AOTA, and ASHA also dig into some specifics when it comes to adequate habilitation and rehabilitation coverage, including:

• Using the definition of habilitative and rehabilitative services adopted by the US Department of Health and Human Services
• Creating separate rather than combined visit limits for physical therapy, occupational therapy, and speech-language pathology
• Ensuring direct access to all 3 therapies
• Providing clear information to consumers on whether benefits can be delayed due to utilization management practices, whether telehealth is permitted, and if same-day physical therapy, occupational therapy, and speech-language pathology services are allowed

As for recommendations for plan improvements, the 3 organizations offer 14 ideas they believe would advance "optimum value" and increase patient access to therapy services. Those suggestions include wider use of telehealth, recognition of the role of therapy providers in population and preventive health, ending policies that limit coverage of each therapy discipline to 1 condition, and stronger acknowledgement that "rehabilitative maintenance therapy and habilitative services are allowed for individuals with chronic, progressive conditions…to prevent further deterioration of function."