Gabriel Rosenberg Dyspraxia/DCD Coverage Act
Gabriel Rosenberg Dyspraxia/DCD Coverage Act would require the Comptroller General (the head of the Government Accountability Office, GAO) to conduct a comprehensive study of insurance coverage for treatment of dyspraxia/developmental coordination disorder (DCD). Within one year of enactment, GAO would prepare a report examining how such items and services are covered across major health coverage systems, including group and individual health plans, Medicare, Medicaid (state programs), FEHB (Federal Employees Health Benefits Program), and other Federal health programs. The study would map current coverage, identify gaps and barriers (such as age limitations or provider scarcity), assess compliance with existing parity requirements, and offer recommendations for improving coverage and potential CMS guidance. The bill does not itself require new coverage, but aims to illuminate coverage realities and guide policy decisions. Potential impact: If enacted, the bill would generate a data-driven assessment that could influence insurers, employers, federal programs, and policymakers to improve access to evaluation and treatment for DCD/dyspraxia. It could lead to changes in coverage policies, expanded access for affected individuals, and better alignment with mental health/parity provisions and other health coverage requirements.
Key Points
- 1Study mandate and scope: The Comptroller General must conduct a nationwide study and submit a report detailing how items and services related to DCD are covered under group health plans, group and individual health insurance, Medicare, Medicaid, FEHBP, and other Federal health programs.
- 2Coverage specifics to be examined: The study will detail whether coverage exists, what types of services are covered, and any age cutoffs or limits, as well as barriers to coverage (e.g., provider availability).
- 3Compliance and parity focus: The study will assess whether current coverage complies with section 2726 of the Public Health Service Act (parity and related coverage requirements) and examine how well plans meet those standards.
- 4Gaps and adult transition concerns: The study will consider whether children with DCD lose coverage as they become adults due to diagnostic criteria or coverage rules, and identify gaps related to adult coverage.
- 5Recommendations and CMS guidance: The GAO report will include recommendations on how the Centers for Medicare & Medicaid Services (CMS) should issue guidance for Medicare/Medicaid coverage and how group plans and private insurance might be improved to provide better coverage for DCD-related items and services.