As a part of essential health benefits to be established under the Health Care Exchanges it is important that the IOM consider benefits’ coverage decisions based on effectiveness over cost. and determine essential health benefits based on a national standard of evidence-based medicine divorced from politics and policymakers’ influence.
Last week at a meeting held by the Institute of Medicine (IOM) and attended by APTA, rehabilitation stakeholders presented on mandatory rehabilitation and habilitation services as a part of essential health benefits to be established under the Health Care Exchanges. Peter Thomas, representing the Consortium for citizens for Disabilities, Marty Ford, representing the Arc and United Cerebral Palsy Disability Policy Collaboration, and Gary Ulicny, representing the American Congress of Rehabilitation Medicine, were the invited presenters for the mandatory rehabilitation and habilitation services and devices category. Ulicny stated that rehabilitation outcome measures are difficult to establish because multiple providers are involved as a team in the delivery of that type of health care. He stressed that IOM’s panel should not use the Medicare model for determining rehabilitation services as it was designed for a population of individuals over 65 years old, with a primary focus on orthopedic benefits. He added that “improvement” for many individuals receiving rehabilitative services is to regain and maintain functional capacity and preventing deterioration (eg, spinal cord and/or traumatic brain injuries). IOM panel members engaged the experts in discussions about evidence supporting rehabilitation services and clinical decision making regarding the allowance of rehabilitation benefits. Private insurers urged caution in overexpansion of benefits due to costs concerns which could potentially result in high premiums. Both the government representatives and the private insurer representatives stated that, currently, their benefits’ coverage decisions are based on effectiveness over cost. Several speakers stressed that the determination of the essential health benefits should be based on a national standard of evidence-based medicine divorced from politics and policymakers’ influence.