The ABCs of ABA: Part Four of Four

Frank By Attorney Franklin J. Hickman 


The Affordable Care Act, as implemented in Ohio, requires covered health plans to pay for up to 20 hours per week of Applied Behavior Analysis (ABA) or other comparable evidentiary-based services for children up to 21 years of age diagnosed with Autism Spectrum Disorder. This is an extraordinary advance for families with children with autism. While the implications and implementation of this directive are not fully realized at this point; the following provides some guidance based on information available to date.



The Affordable Care Act requires States to ensure that covered plans include specified Essential Health Benefits (EHB). EHBs are listed at 45 CFR 156.110 and include rehabilitative and habilitative services and devices. "Habilitative Services" are not defined in the Federal rules; States have discretion to define services to be included in this category. 45 CFR 156.110(f).


On December 26, 2012, Governor Kasich confirmed that Ohio was exercising its authority to define habilitative services as follows:



From Our Blog: ABLE Act - Dream Come True, or Wake-up Call? Maybe Both.
Any day now, and likely come New Year's Day 2015, there's a good chance that individuals with special needs (and people who care about them) will be able to set up an ABLE Account (stands for Achieving a Better Life Experience). We've been following the bills (S. 313 and H.R. 647 as amended on 7/31/14) and their unusually promising path (bipartisan and bicameral, by Jove) toward becoming an actual law when Congress reconvenes this fall. When all is said and done, the upshot is likely to be essentially a tax-favored, 529-type plan for the child whose disabilities manifest before age 26 to be used for education, housing, transportation, and the like. In light of its Medicaid-payback-at-death provision, the ABLE Account won't be a countable resource for purposes of needs-based benefits like Medicaid and SSI (no matter how large it swells over time for Medicaid, but with a $100,000 maximum for SSI). There would be no fancy lawyers, no special "trusts," no sticker-shock. Too good to be true? Maybe.


Volume 4, Issue 7





Attorneys Lauren Hamilton and Linda Gorczynski join the Hickman & Lowder legal team.

Attorney Franklin Hickman has been selected for inclusion in the 21st Edition of Best Lawyers in America.




Upcoming Event


Understanding Financial Elder Abuse: The Crime, The Shame,
The Solutions
Friday 10/10, Sandusky, Ohio 

CPAs, CFPs, and Insurance Agents will earn CE credit at this informative symposium, featuring two presentations by Care Coordinator Terry Fries-Maloy, MSW, LISW.

Click here for details.



Sonja's Suggestions

Topics trending in the reception area of our Cleveland office. 


Recent conversations with clients who expressed loneliness made me think about the subject. The loneliness one feels after the loss of a loved one must be a difficult thing to overcome. Individuals who are in a facility with no friends or family for visitations must feel all alone in the world, too. I have heard clients say, "This too shall pass," and, hopefully, it will.


Here are some suggestions for resolving your own loneliness or assisting someone else through theirs:


 Read More


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