Thursday, September 12, 2013

Affordable Care Act : Michigan health plans and coverage for special needs children

This is from the Detroit Free Press, 9/12/13, on "What Michigan health plans must offer" under the Affordable Care Act: 
  • Ambulatory patient services.
  • Outpatient care that includes visits to primary care doctors, home health care services and hospice care, though some carriers might limit this to no more than 45 days.Emergency service.
  • Visits to the emergency room and ambulance transportation.Hospitalization.
  • Surgeries, transplants and care in a skilled nursing facility, though some carriers may limit the latter to no more than 45 days.Maternity and newborn care: Prenatal care, delivery and postnatal care.
  • Inpatient and outpatient mental health and substance abuse services: Some carriers may limit this to 20 days each per year.
  • Prescription drugs: Includes commonly prescribed drugs and specialty drugs, a class known for its extraordinary high cost per dosage.
  • Rehabilitative and habilitative services and devices: Allows 30 visits per year for physical therapy, occupational therapy or chiropractor services, 30 visits for speech therapy and 30 visits for cardiac or pulmonary rehab.
  • Laboratory services: X-rays, CT scans and breast cancer diagnosis tests.
  • Preventive and wellness services: Chronic disease management and immunizations.
  • Pediatric services: Oral and vision care and more.
[Source: Detroit Free Press research]


For special needs children, the Catalyst Center has published a document called "The Affordable Care Act - A side-by-side comparison of major provisions and the implications for children and youth with special health care needs from the Catalyst Center". The center is "a national center dedicated to improving health care coverage and financing for Children and Youth with Special Health Care Needs (CYSHCN)". This publication gives a detailed description of what is required by the ACA, the provisions that are already in effect, soon to be implemented provisions, and the implications for children with special needs.

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