California “Parity Bill” Introduced
On Friday, February 18, Assembly Bill 976 was introduced by Assembly
Member Bill Emmerson R-San Berardino, which will require coverage of
orthotic and prosthetic devices, upon prescription, for all children
under the age of 18 who are covered by private insurance, including
managed care.
Emmerson had met with COPA Lobbyist, Nick Medeiros, over the Winter
Recess to discuss language to require coverage for all insured
Californians regardless of age, but was later informed that all new
coverage bills must go through a study process taking up to one year
before they can be heard in committee.
Emmerson didn’t want kids to have to wait one more year while the issue
of coverage is studied and is pushing it forward immediately. COPA is not
opposed to the study of coverage for adults and is confident that the
economic reasonableness of the issue will be evident at the end of the
study. COPA is cerrtainly not giving up on the adult population, but is
working within the parameters placed by the Legislature. If Emmerson
thinks he can get minors covered this year, that’s a gift we’ll happily
receive while we work on coverage for everyone.
COPA will work with the Legislature on the issue of full coverage for
all Californians, while Emmerson pursues the issue on behalf on minors.
The University of California system will independently study the benefit
proposal and produce a report on the subject. Because the issue is
comparatively narrow in focus, it is assumed that much of the input for
the study will come from O&P professionals and academicians. The Amputee
Coalition of America will also provide necessary input from consumers.
Unlike several previous “parity” bills in other states, AB 976 includes
two important clauses that will promote better care of O&P patients. The
bill does not tie reimbursement to Medicare rates thus condemning payment
to a potentially low level. It also requires that providers follow the
same rules of the Medi-Cal system, meaning that all participating
providers must be certified by the American Board for Certification or
the Board for Orthotist Certification. It is strong, consumer-driven
legislation that will make a big difference in patients’ lives.
Letters of support are urgently needed for Assembly Bill 976. Simple one
to two paragraph letters stating the need to cover orthotics and
prosthetics for children under private insurance in California must be
forwarded to Assemblymember Bill Emmerson’s office as soon as possible so
that they can be reflected in the analysis that will be before the
committee members voting on the measure in early April. Letters of
support should also be addressed to each legislator representing the
district in which O&P businesses are located. To find out which
legislator represents your district, visit: www.leginfo.ca.gov and click
“Your Legislature” bar which will bring you to a search by zip code
function.
A letter of support should also be sent to: Assemblymember Bill
Emmerson, State Capitol, Room 3149, Sacramento, CA 95814. To ensure that
your support is reflected in the committee analysis, please fax a copy of
your letter to COPA’s administrative office at 209-744-2673.
Consumer support, especially from families with children using orthotics
and prosthetics, is critical to the bill’s passage. Please make every
attempt to encourage patients to write and call their legislators as
well. If any are willing to travel to Sacramento to provide testimony,
please forward their name and phone numbers to COPA.
A sample letter is posted at COPA’s web site, at www.oandp.com/copa.
Please use the example as a suggestion, as legislators do not give any
weight to “form letters.” If you need assistance in composing a letter or
have any other questions regarding the bill, please call Sherry Daley, at
209-744-2672. To follow the bill’s progress through the legislative
system, visit www.leginfo.ca.gov and click on “Bills” and then enter AB
976.
While pursuing reform at both the legislative level and through the
court system, COPA is also pursuing assistance from two state agencies
with rule-making authority over insurers in California.
Upon completing its legislative draft to require insurance coverage from
managed care companies, Assemblyman Emerson’s office was notified that
legislation of this nature would be duplicative, indicating that their
interpretation of the law is that these items are already mandated.
COPA is pursuing the issue of exactly what current code means in terms
of coverage, with the Department of Managed Care. A letter has been sent
to Lucinda “Cindy” Ehnes the Department’s Director, requesting that her
staff review the current code and enforce its provisions relating to O&P
coverage.
The letter states, “The law mandating coverage orthotics and prosthetics
was changed in 1992 to ban “one leg per lifetime” limitations and other
over burdensome restrictions to orthotics and prosthetics provision and
yet most managed care entities continue to ignore these provisions.” It
asks the Director to specifically, “notify all managed care companies
that they are in violation of the law and must discontinue the illegal
provisions common in many of their plan offerings. Specifically, it is
necessary that the O&P category be separated from the DME category and be
addressed in the same fashion that internal prosthetic devices,
laryngectomy and mastectomy devices are handled (no extensive co-pays, no
caps).”
The Director has responded with a request that COPA meet with her to
discuss the issue in detail. A meeting time is being arranged for this
purpose.
COPA has also received word that the Division of Workers Compensation
has received the association’s request for review of new code sections
that require all workers’ compensation providers to follow the same
reimbursement rules as found under the state’s Medi-Cal payment system.
The request has been forwarded to the Division’s legal department and
according to staff, an answer should be forthcoming “very soon.”
Isn’t it a wonder that this association is working so earnestly for the
industry in California and yet so many large and small companies do not
belong as members. Anyone wishing to correct this imbalance can e-mail
COPA’s Public Policy Director, Sherry Daley, at [email protected] and she
will e-mail you an application.
