WHILE CONGRESS RESTS, POWER SHIFTS TO DEPARTMENT OF HHS
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 orthotic and prosthetic
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 use
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 they place caps on 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 over 40 other national rehabilitation and disability
organizations, argued forcefully in written public comments that HHS should:
(1) 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
(2) 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.
Visit our website:
www.naaop.org
