Habilitative Care Covered in Illinois

Released: 12/21/2009

FOR IMMEDIATE RELEASE: Habilitative Care Covered in Illinois

April 7, 2009 For more information contact:

Scott G. Allen, MS, Executive Director
sallen@illinoisaap.com or 312/733-1026, ext 202

Chicago, IL, April 7, 2009 – Today, Governor Pat Quinn signed legislation allowing access for children who would benefit from various therapies like physical therapy, speech therapy and occupational therapy into law. Senate Bill 101 from the 95th General Assembly requires insurance companies to cover these medically necessary therapies for children born with conditions such as autism, cerebral palsy, down syndrome and other neurological conditions.

Senator M. Maggie Crotty and Representative Beth Coulson championed the legislation so insurance claims would no longer be denied because the therapy was “habilitative” in nature. Some insurance companies were approving coverage to help a child recover previously acquired skills lost because of injury or illness since the therapy was rehabilitative in nature. However, in many cases, denials were given for care (and called “habilitative” in nature) if the child had not previously developed basic skills such as walking or talking.

“The system was confusing and discriminatory to families,” Sen. Crotty explained. “In recent years, insurance companies have denied these critical therapies for some children, while turning down coverage for others. This law rectifies inconsistent coverage for kids who have been punished for no good reason. In these tough economic times, we are pleased to take just one major expense off the backs of hard-working families who are trying to give their kids basic skills to help them reach their true potential.”

“As a physical therapist, I have personally witnessed the amazing recovery of children who have access to habilitative services. Many children who receive habilitative services demonstrate tremendous improvement and progress. Covering the costs of these services has the potential to improve a child’s overall development and quality of life,” Rep. Coulson said.

State programs in Illinois already provide habilitative care to most Medicaid patients, but there was no requirement for private insurers to do so. Pediatricians have long been frustrated when trying to obtain habilitative care for their patients with private insurance. Families with children needing medically-indicated, available therapies to acquire basic skills have had to pay for the services themselves or forgo them. This sacrifices a window of opportunity to enhance a child’s functioning in daily life activities.

Health care providers and families know that suboptimal intervention early in life not only impacts how a child performs in the short-term but can have detrimental effects on long-term outcomes. “This law will go a long way toward the goal of each child in Illinois receiving the therapies they need to achieve their true potential,” said Dr. Ed Pont, Past-President of the Illinois Chapter of the American Academy of Pediatrics (AAP).

Alan Rosenblatt, MD, FAAP, a neurodevelopmental pediatrician, used his experience working on a Maryland law to push for similar reform in Illinois. “I knew from the Maryland bill that we could affect the care of children with a wide range of conditions, from cerebral palsy and other motor disorders to language and cognitive disabilities to those with sensory impairments and genetic conditions,” Dr. Rosenblatt said. Analysis of the economic impact of the Maryland habilitative care law showed that the cost of that mandate was less than 0.1% of the average annual insurance premium. Habilitative care legislation as encompassing as that in Illinois and Maryland exists only in the District of Columbia, which passed a similar measure in 2006.

“We need this type of legislation to ensure coverage of the unique and important therapies children with congenital, genetic or early acquired disorders require,” Dr. Rosenblatt said. “This will help children with autism and countless other delays and disorders maximize their true potential.”

Pediatricians available for interviewing on this story include:

Edward Pont, MD
Office 630/832-3100
Fax 630/832-1604
Pager 630/683-1300
edpont@pol.net

Alan Rosenblatt, MD
Office 773/481-1818
Fax 773/481-1919
airmd@sbcglobal.net

Reporters seeking other contacts to interview including families who were affected by denials should contact Scott Allen of the Illinois Chapter, American Academy of Pediatrics at sallen@illinoisaap.com, or 312/733-1026, ext 202. Photos from the signing will be available from the Illinois Chapter, American Academy of Pediatrics on April 8, 2009.

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