The National Association for the Advancement of Orthotics and Prosthetics (NAAOP) has released the following statement regarding healthcare reform:
The U.S. House of Representatives voted by a slim margin of 220 to 215 to pass a massive healthcare-reform bill on Saturday, November 7. Entitled the “Affordable Health Care for America Act,” HR 3962 includes provisions that impact the O&P profession in positive ways, but reconciling the bill with the Senate version will bring several challenges to the O&P field.
The House legislation would provide private insurance for over 25 million without current coverage and includes a modified “public insurance option” that would utilize negotiated provider reimbursement rates (rather than Medicare rates), allowing states to establish their own public option rather than relying on a national one. The bill significantly expands Medicaid eligibility-to 150 percent of the federal poverty level (FPL), compared with 133 percent in the original House bill and in the Senate legislation. The bill also creates health insurance “exchanges” that would serve as new web-based marketplaces to shop and compare private insurance plans, establishes new consumer protections in the sale and premium rating of private insurance, and provides federal subsidies to low income individuals and families to help purchase coverage.
Coverage of Orthotics and Prosthetics in Private Insurance
Notably, the House bill specifically recognizes coverage of orthotics and prosthetics in the essential benefits package that all private health-insurance plans must cover if they operate under the new health-insurance exchanges. This is a major improvement to the House bill from the original version in June, which did not include coverage of O&P care, and demonstrates that strong and persistent advocacy can achieve results in Washington.
Protecting the O&P Fee Schedule
To offset the cost of covering 25 million uninsured persons, Congress has proposed to impose a series of reimbursement cuts to providers if the bill is implemented, including the inclusion of new “productivity adjustments” in the market basket used to set annual updates for a wide range of providers. Considering the fact that almost every provider group, except physicians, is slated to have their updates reduced in this bill, including durable medical equipment, the O&P field fared well in the House legislative process. The House bill does not cut or reduce O&P CPI updates, nor does it impose productivity adjustments.
While the House bill’s productivity adjustments do not impact the orthotic and prosthetic fee schedule, the Senate Finance Committee provisions do. The Senate bill would permit annual CPI updates to the O&P fee schedule to be reduced by a factor based on “productivity” and efficiency of providing health care. In other words, the Medicare program’s fee schedules will be adjusted downward by amounts determined to correspond to the increases in efficiency in the general economy. The link between these two factors is highly suspect, and NAAOP and its Alliance partner organizations will be monitoring this closely and advocating over the coming weeks and months to protect the integrity of the O&P fee schedule during healthcare reform.
