The "Gabriel Rosenberg Dyspraxia/DCD Coverage Act" mandates a comprehensive study on insurance coverage for dyspraxia/developmental coordination disorder (DCD) under various health plans and federal programs, with recommendations for improved coverage.
Michael Lawler
Representative
NY-17
The "Gabriel Rosenberg Dyspraxia/DCD Coverage Act" mandates a comprehensive study by the Comptroller General to assess insurance coverage for dyspraxia/developmental coordination disorder (DCD) across group health plans, individual health insurance, and federal healthcare programs. This study will investigate the extent of coverage, barriers to access, and compliance with existing laws, as well as provide recommendations for improving coverage and addressing potential gaps in care. The ultimate goal is to ensure individuals with dyspraxia/DCD receive adequate and consistent healthcare coverage throughout their lives.
Congress Mandates Study on Dyspraxia/DCD Insurance Gaps: Key Findings Expected Within 12 Months
This bill, the "Gabriel Rosenberg Dyspraxia/DCD Coverage Act," doesn't change insurance rules overnight. Instead, it kicks off a fact-finding mission. Specifically, it directs the Comptroller General – basically, the government's top auditor – to conduct a comprehensive study on how health insurance currently covers treatments and services for dyspraxia, also known as Developmental Coordination Disorder (DCD). The findings are due back to Congress within one year.
Digging into the Details: What Will the Study Cover?
The core task here, outlined in Section 2, is to get a clear picture of the current insurance landscape for dyspraxia/DCD across the board. This includes:
- Employer-sponsored plans: The kind many people get through work (group health plans as defined in Sec. 2791 of the Public Health Service Act).
- Individual market plans: Insurance people buy on their own.
- Government programs: Medicare, state Medicaid programs, and other federal health care programs (like the Federal Employees Health Benefits Program under Chapter 89, Title 5, U.S. Code).
The study needs to answer some critical questions: Are services for dyspraxia/DCD actually covered by these plans? What types of services (like occupational or physical therapy) typically get the green light? Are there age limits that cut off coverage, potentially leaving adults who were diagnosed as children without support? What are the biggest roadblocks people face when trying to get coverage?
Checking for Fairness and Looking Ahead
A key part of this investigation involves checking if insurance plans are playing by the existing rules, specifically Section 2726 of the Public Health Service Act. That's the law requiring parity between mental health/substance use disorder benefits and medical/surgical benefits. The study will assess if plans are generally meeting these requirements when it comes to dyspraxia/DCD.
Ultimately, this isn't just about collecting data. The report must include recommendations for potential improvements. This includes advice for the Centers for Medicare & Medicaid Services (CMS) on guidance for Medicare and Medicaid, and suggestions for how private insurance (group and individual plans) could enhance their coverage. Think of this bill as drawing the map – identifying where the coverage deserts and obstacles are – before potentially charting a new course for accessing care.