On August 6, the National Association for the Advancement of Orthotics & Prosthetics (NAAOP) issued the following update on current healthcare policy and its potential impact on the O&P profession:
Definition of Orthotics and Prosthetics
Now that the healthcare reform bill, the Patient Protection and Affordable Care Act (known as PPACA or the Affordable Care Act), has been enacted, the extensive work of implementing the bill has begun. As part of that process, the Department of Health and Human Services (HHS), in conjunction with the National Association of Insurance Commissioners (NAIC), will be developing regulations and standards to which insurance plans must comply in order to operate within state Health Insurance Exchanges, set to take effect in 2014.
The NAIC held a series of interim meetings on healthcare-reform implementation in July. At these meetings, the commissioners presented draft definitions of “rehabilitation” services and “durable medical equipment” (DME), two terms that must be defined so that consumers can easily compare coverage across private health plans. NAAOP, along with its Alliance partners, attended these meetings and were ready with recommendations to ensure that O&P is not defined as durable medical equipment. Instead, we are advocating that the NAIC separately define “orthotics and prosthetics.” Toward that end, we suggested a definition for NAIC to adopt: “‘prosthetics’ includes artificial legs, arms, and eyes and ‘orthotics’ includes leg, arm, back, and neck braces that are ordered by a healthcare provider, including replacements due to wear, damage, or a change in the person’s medical condition.” These definitions are intentionally simplistic and are designed to be understood by a wide range of healthcare consumers who may know very little about healthcare terminology.
In connection with this advocacy, we also pointed out to the NAIC that Congressional intent lays the foundation for the NAIC to use its discretion to include a separate definition in the list of medical terms for “prosthetics and orthotics.” House Education and Labor Chairman George Miller (D-CA) explicitly stated in his floor statement during House passage of the bill that Congress intended to include prosthetics and orthotics in the essential benefits package under the term “rehabilitation and habilitation services and devices.” Congress also intended to define prosthetics and orthotics separately from “durable medical equipment” in the definitions section of the Affordable Care Act. NAAOP was a leader in ensuring this floor statement was submitted for the written record by Chairman Miller.
Vital Medicaid Funding Proposal Passes the Senate
The Senate voted 61 to 39 on August 5 to finally send to the House of Representatives a $26 billion state aid package that would provide $16.1 billion to extend enhanced Medicaid funding for states. The Federal Medical Assistance Percentage (FMAP) funding proposal had been attached to several legislative vehicles over the past months, but each time it was stripped or the vehicle failed to pass in the Senate. The funding is enough of a priority for Democrats that Speaker Nancy Pelosi (D-CA) has called back the full House of Representatives from recess next week to vote on the bill. Speaker Pelosi’s decision on Wednesday afternoon came hours after the Senate achieved cloture on the legislation due to the support from Maine Republicans Susan Collins and Olympia Snowe.
The package extends by six months enhanced federal Medicaid payments, so that states will have enhanced funding until the end of fiscal year 2011. The recovery bill (also known as the “Stimulus Package”) enacted last year included the initial increase of funds for Medicaid, but these increases are scheduled to expire by December 31, 2010, halfway through most states’ fiscal year. The Senate bill stops short of extending the funding until June at its current amount. Instead, the bill phases down the funding until it runs out in June 2011. This Medicaid funding increase, along with approximately $10 billion in increased education funding to prevent teacher lay-offs is fully “offset” by other spending reductions, namely, changes in the tax code and rescissions of other funding, including money meant to extend the food stamp program.
The National Conference of State Legislatures reports that most states have budgeted for the upcoming fiscal year on the assumption that Congress will approve a six-month extension to the enhanced FMAP. Without the extension, state governments have warned of drastic cuts to Medicaid benefits and reimbursement rates.
Even with the enhanced funding contained in this new bill, most states are under serious pressure to reduce expenditures, and Medicaid is always a likely target. In this respect, the O&P community must remain vigilant to oppose any cuts in Medicaid coverage throughout the states. Just recently, the O&P community has seen the threat of reduced O&P coverage become reality, as Arizona decided to eliminate orthotic coverage for adults over 21 years of age and California contemplated significant cuts in O&P coverage, only to restore them after public opposition to these proposals.
NAAOP will continue to keep its membership informed of developments as they occur. For more information, visit www.naaop.org or e-mail [email protected]
