Behavioral modification programs: HSA Eligibility

Behavioral modification programs may be eligible with a flexible spending account (FSA), health savings account (HSA) or a health reimbursement arrangement (HRA) when required for the treatment of a specific medical condition. For a dependent care flexible spending account (FSA), behavioral modification programs are eligible if they are for a qualified child or relative and allow the parent or guardian(s) to be gainfully employed, search for gainful employment or a full-time student(s). Behavioral modification programs are not eligible for reimbursement with a limited care flexible spending account (LCFSA).

What are behavioral modification programs?

Behavior modification is a treatment plan designed around the concept of operant conditioning, or the examination of negative behaviors and an effort to replace those with more desirable behaviors through positive and negative reinforcement. This technique has been successful in the treatment of a wide range of psychological conditions, including phobias, obsessive compulsive disorder (OCD), enuresis, separation anxiety disorder, attention-deficit/hyperactivity disorder and other generalized anxiety disorders. Each of these conditions utilize behavioral modification in varying ways, and medical professionals can combine it with other treatments to form an effective strategy to alleviate the condition/related behaviors.

The term "operant conditioning," which lies at the heart of the practice of behavioral modification, was coined by psychologist B.F. Skinner in the mid-20th century, and is designed to examine behavior and the causes of an action and its consequences. One of the most common methods within this strategy is positive reinforcement, which is a series of rewards that are earned by continually performing certain behaviors or strategies. A contract is often drawn up so the patient knows exactly how he/she can work toward a goal, and gradually these desirable actions are meant to replace the negative behaviors.

Conversely, some psychological conditions/behaviors are treated with negative reinforcement, in which the patient will incur some type of penalty for indulging in undesirable behavior. For instance, if an individual is trying to quit smoking, one example of negative reinforcement is being forced to pay $5 each time he/she gives into a craving. Additionally, negative reinforcement has roots in child-rearing, as withholding privileges like television, toys or other activities when negative behavior arises provides incentive for kids to curb unwanted actions.

How do I obtain a Letter of Medical Necessity (LMN)?

A Letter of Medical Necessity (LMN) from a doctor for behavioral modification programs is necessary for reimbursement with most benefits providers to ensure that it is necessary for the treatment of a medical condition. This letter must outline how an account holder's medical condition inhibits his/her ability to perform daily tasks or diminish quality of life, how the treatment will be used to alleviate the issue and how long the treatment will last. If the treatment plan exceeds the current plan year, another LMN will have to be provided to the benefits administrator to cover the duration of the treatment.

Eligibility Table

Flexible Spending Account (FSA) Limited Care FSA Dependent Care FSA Health Savings Account (HSA) Health Reimbursement Account (HRA)

Eligible

Eligible with Rx

Eligible with LMN

Not Eligible

 


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