The National Association for the Advancement of Orthotics and Prosthetics (NAAOP) has issued a statement regarding the national healthcare-reform debate. The statement appears in its entirety below:
Of the many issues to report in the current debate in Congress over health care reform, it has become clear that the O&P benefit is being treated separately from durable medical equipment (DME). There are several examples that illustrate this separate treatment, and, because this has been a long-standing goal of NAAOP and the O&P profession, these examples are highlighted below. However one feels about the healthcare-reform bills emerging from Congress, it is heartening to know that to date, leaders in Congress finally appear to understand that DME and O&P are separate and distinct, and should be treated differently for policy purposes. This comes after many years of education of policymakers by NAAOP and other O&P organizations. While the O&P profession must remain vigilant, it is an encouraging sign.
- Separate coverage in essential-benefits package: One measure of the separate treatment of DME and O&P can be seen in the healthcare-reform legislation passed out of the House Education and Labor Committee in late July. The leadership of this committee addressed the concerns of NAAOP, Alliance organizations, and disability groups by clarifying that all private health plans that participate in a new “Health Insurance Exchange” must cover assistive devices for people with disabilities. In the past, it was typical for Congress to have simply included a specific reference to “durable medical equipment,” assuming that orthotics and prosthetics would be included within the confines of that term. However, the Committee bill states in statute that “durable medical equipment, prosthetics, orthotics and supplies” are considered “essential benefits” under all private health-insurance plans offered under the Exchange. Not only does this language make it clear that O&P benefits are covered, but it draws an explicit distinction between these benefits and durable medical equipment.
- O&P spared by amendment that cuts DME fee schedule: On the last day of the House Energy and Commerce Committee’s mark-up of health-reform legislation, an unexpected amendment was offered to improve cancer treatment and reimbursement under the Medicare program. To help pay for the cost of these changes, an offset was proposed that would reduce the annual CPI-U increase to the Medicare DME fee schedule by one half of one percent each year for the next four years. The amendment passed, and the amendment was added to the underlying health-reform bill reported out of the Energy & Commerce Committee. While this is bad news for DME suppliers and will likely be aggressively fought by that field, the reduction in reimbursement does not apply to the O&P fee schedule. This is largely due to the fact that the Medicare statute lists the O&P benefit in a separate place from the DME benefit. O&P is separate and distinct from DME in the law and the legislation adopted by the Energy & Commerce Committee recognized that fact. The committee did not automatically assume that DME includes O&P, and this separate treatment accrued to the benefit of the O&P profession.
For a profession that has long sought separate and distinct treatment from policymakers, these developments offer significant evidence that the advocacy efforts of NAAOP and the Alliance organizations over the past decade or more are having the desired effect.