Habilitation therapy services are services that help you keep, learn, or improve skills and functioning for daily living (e.g., therapy for a child who isn’t walking or talking at the expected age).

Your physician prescribes habilitation therapy services, which must be performed by:

• A licensed or certified physical, occupational or speech therapist;
• A hospital, skilled nursing facility, or hospice facility;
• A home health care agency;
• A physician.

Eligible health services include the following, except for services provided in an educational or training setting:

• Physical therapy, if it is expected to develop any impaired function.
• Occupational therapy (except for vocational rehabilitation or employment counseling), if it is expected to develop any impaired function.
• Speech therapy (except for services provided to teach sign language), if it is expected to develop speech function as a result of delayed development. (Speech function is the ability to express thoughts, speak words and form sentences.)

Autism spectrum disorder is defined in the most recent edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM) of the American Psychiatric Association.

Eligible health services include the services and supplies provided by a physician or behavioral health provider for the diagnosis and treatment of autism spectrum disorder. (Aetna will only cover this treatment if a physician or behavioral health provider orders it as part of a treatment plan.)

Aetna will cover certain early intensive behavioral interventions, such as applied behaviorial analysis. Applied behaviorial analysis is an educational service that is the process of applying interventions:

• That systematically change behavior, and
• That is responsible for observable improvements in behavior.