The National Association for the Advancement of Orthotics & Prosthetics (NAAOP) has issued the following update on current healthcare policy and its potential impact on the O&P profession:
All is quiet on the legislative front as the Congressional summer recess winds down and lawmakers gear up for what promises to be another very busy and contentious election season. In the meantime, however, it is high season for the healthcare regulatory agencies, with the Department of Health and Human Services (HHS) churning out proposals at record speed to keep up with the schedule for healthcare-reform implementation as outlined in the new law, the Patient Protection and Affordable Care Act (PPACA). NAAOP is actively engaged in this regulatory process and is working hard to comment on health-reform regulations that affect the O&P profession.
NAAOP, though its membership in three coalitions, including the O&P Alliance, took a lead role in responding to the interim final regulations on patient protections. These regulations include rules forbidding the future use by insurance companies and health plans of pre-existing conditions exclusions in the group and individual insurance markets, as well as restrictions on the use of lifetime and annual caps on insurance coverage. All of these patient protections accrue to the benefit of people in need of O&P care and the providers who serve them.
The new health-reform law (PPACA) prohibits insurance companies from imposing pre-existing condition exclusions on children under 21 years of age in all group and individual plans beginning September 26, 2010. Adults are covered under this policy in 2014. The new law also prohibits plans from setting lifetime limits on coverage of “essential health benefits” and from setting unreasonable annual limits prior to 2014, with all annual limits phasing out once new health insurance “exchanges” are established and operational in that year.
Since these new restrictions only apply to the provision of “essential health benefits,” the definition of this term is critical to the O&P field. The PPACA mandates that insurance plans sold through exchanges include coverage of “rehabilitative and habilitative services and devices” as an essential health benefit. While there is good legislative history that this category of benefits includes coverage of O&P care, the statute does not further define the scope of all categories mandated as essential by PPACA. HHS may not publish the proposed regulation on the essential benefits package until 2011 or beyond and, therefore, continued advocacy is critically important to ensure that O&P services and devices are considered essential benefits.
When fully operational in 2014, these protections will significantly assist consumers of O&P care to access appropriate treatment, but in the meantime, unintended consequences may occur. For instance, incentives exist for insurance health plans to shrink their core benefit plans so as to broaden the kinds of services upon which they place caps in the short term. These kinds of incentives are not only a threat to patients trying to access coverage prior to 2014, but may set up a poor precedent for the regulatory battle that will define the basic benefit package for decades.
To counteract these threats to coverage of O&P and other services, NAAOP, along with more than 40 other national rehabilitation and disability organizations, argued forcefully in written public comments that HHS should:
- impose a regulatory moratorium on all new annual caps on essential benefits imposed by health plans that did not impose annual limits prior to the bill’s enactment; and
- use its authority to prohibit all coverage changes that would subvert the intent of the PPACA’s prohibitions on lifetime and unreasonable annual caps as well as the prohibitions on pre-existing condition exclusions (i.e. intentionally shrinking benefit coverage to avoid the new restrictions, with the effect of limiting medically necessary services).
NAAOP will continue to advocate on behalf of the O&P community for fair and thorough coverage of O&P care during healthcare-reform implementation. We are continually reaching out to establish new contacts and create new allies within HHS and Congress to ensure that the O&P community is best served by these insurance reforms. HHS has also published a series of proposed rules in addition to the consumer protections rule and we will be commenting as necessary.
Monitoring, analyzing, and commenting on the vast array of regulations associated with national health care reform is a daunting task. We thank NAAOP members for their support and encourage others to join NAAOP today so we may continue to work hard for the O&P profession.
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]
