New law helps Illinois kids get therapies; young people with disabilities: April 14, 2009: Chicago Tribune

By Judith Graham

Illinois will extend assistance to parents of children with Down syndrome, cerebral palsy, autism and other developmental disorders under a new law (Senate Bill 101) signed by Gov. Patrick Quinn last week.

For the first time, the law will require insurance companies to pay for these youngsters’ speech, physical and occupational therapies. Specifically, it says insurers must treat so-called "habilitative" therapies for youngsters with developmental disabilities in the same way they treat "rehabilitative" therapies.

The measure, strongly supported by the American Academy of Pediatrics, goes into effect Jan. 1, 2010.

Habilitative therapies are designed to teach a person new skills and maximize functioning; rehabilitative therapies are designed to help someone recover skills that have been lost.

Think of a 5-year-old with cerebral palsy who needs help learning how to walk and talk. Insurers routinely deny reimbursement for physical and speech “habilitative” therapy on the grounds that these are educational, not medical, services, said Dr. Alan Rosenblatt, a Chicago pediatrician.

If, however, a child walked and talked and then became unable to do so because of an accident, the same insurer routinely covers “rehabilitative” therapies to help restore those skills, deeming those medical necessary services.

The new law won’t allow those kinds of distinctions for children with developmental disabilities up to the age of 19. As a result, more children should start receiving habilitative therapies and families that have paid out of pocket for the services will get financial relief.

"Research shows early intervention can make a significant impact on the quality of life and long-term potential for children" with developmental disabilities, Rosenblatt said. "This will ensure that Illinois children with disabilities get necessary treatments to help them reach their full potential."

It’s important to note that the law doesn’t require insurers to offer a minimum level of coverage for either habilitative or rehabilitative therapies. Many insurers impose restrictions on any kind of therapy, and those will still apply.

Illinois becomes the third area to enact this kind of legislation, after Maryland and the District of Columbia.