Massachusetts and California Pass Prosthetic Parity Legislation
Massachusetts became the fifth state to ensure comprehensive coverage for prosthetic care under the law. After years of hard work by groups like the Massachusetts Society of Orthotists and Prosthetists, and with support from the Amputee Coalition of America (ACA), Gov. Mitt Romney signed H5256 into law on Sept. 7. H5256 mandates that insurance plans provide coverage for prosthetics that equals the coverage provided for such devices under the federal Medicare laws.
“This will ensure that the tragedy of a child losing a limb is not compounded by forcing that child to spend the rest of their childhood in a wheelchair when help is readily available,” said Morgan Sheets, advocacy director for the ACA.
Presenting a strong case for coverage
Both the financial and social benefits provide a strong case for prosthetic coverage. A report published by Compass Health Analytics for the Division of Health Care Finance and Policy for the Commonwealth of Massachusetts found that the increase in premiums for prosthetic provision would be about 27 cents per month, less than $3.50 per year. In return, the public sector will see a cost savings because appropriate private insurance coverage prevents cost shifting to the public sector.
Cost savings also can be expected in unemployment insurance, state employment and training programs, rehabilitation and counseling programs and other social welfare systems. It is estimated that every dollar spent on rehabilitation, including prosthetic care, saves more than $11 in disability benefits.
Non-fiscal benefits of coverage
There are non-fiscal benefits to providing prosthetic care as well, Sheets said in a press release. They include a reduction in the secondary conditions caused by a sedentary lifestyle, decreased dependence on caretakers and reduced chance of diabetic-related complications leading to additional limb amputation.
“We applaud Gov. Romney for giving people the care they need to live independent, productive lives,” said Paddy Rossbach, president and chief executive officer of the ACA.
California quickly follows suit
On Sept. 30, California became the sixth state to protect prosthetic coverage under the law. Gov. Arnold Schwarzenegger signed AB 2012, a bill that mandates that insurance plans offering benefits for orthotic and prosthetic care must provide full coverage — without caps and copays that restrict access to prescribed devices. The bill will make certain that insured, working people can continue working and supporting their families.
“Currently, when health plans and insurers offer orthotic and prosthetic coverage, they may offer coverage that in reality provides only a small portion of the total costs of a prosthetic limb,” Schwarzenegger said in a press release. “For instance, a health plan may only cover $2,000 of the cost of a prosthetic arm, leaving the patient to pay the remaining cost, which could be $10,000 or higher.”
Mandate O&P provider competency
The bill also mandates that O&P providers will have met a standard level of competency to fit and furnish devices and services by being nationally certified. The bill was sponsored by the California Orthotics and Prosthetics Association and supported by the ACA and its members.
The ACA is part of a national campaign to advance legislation state-by-state requiring insurance companies to cover appropriate prosthetic care.
AOPA Elects Officers and Directors
New officers and directors were elected on Sept. 29 at the annual business meeting of the American Orthotics and Prosthetic Association (AOPA) in Hollywood, Fla. The results of the election were:
- Ronald Ted Snell, CP, previously the president-elect, was installed as president. In addition to his work at C.F.I. Prosthetics and Orthotics in Memphis, Tenn., he is also a member of the coding committee for AOPA.
- Bradley N. Ruhl, president-elect, is vice president of sales and marketing for the technical orthopedic business for Otto Bock HealthCare in the United States. He also served as a member of the Amputee Coalition of America (ACA) board of directors from 1998 to 2004 and was chairman of the ACAs public policy and advocacy committee.
- Brian L. Gustin, CP, vice president, entered the O&P profession with Suburban Orthotics and Prosthetics in Des Plaines, Ill. He later joined his father’s company, Wisconsin Orthopedic in Green Bay, Wis. and expanded the company to six locations and additional mobile service.
- Mark H. Emery, treasurer, is the chief financial officer for Ossur North America. He was the chief financial officer for two publicly held companies and provided consulting services to companies in the health care field.
- Marc C. Karn, CP, director-at-large, is owner and chief executive officer of Maine Artificial Limb & Orthotics in Portland, Maine. He has been active in Maine by successfully initiating legislation which mandates prosthetic coverage for amputee patients.
- Thomas V. DiBello, CO, FAAOP, director-at-large, is president of Dynamic O&P in Houston. He is currently a member of the coding committee for AOPA.
- Anita Liberman-Lampear, MA, director 1-3 facilities, is the administrative director of the University of Michigan Orthotics and Prosthetic Center and an adjunct lecturer at Eastern Michigan University. She is also a board member for the Michigan Orthotics and Prosthetics Association and the association’s liaison to Medicaid and a member of the Medical Care Advisory Council to the director of Medicaid. She is a member of both the Government Relations Committee and Business Optimization subcommittee.
- Russell J. Hornfisher, supplier director, is the director of sales and marketing for Becker Orthopedic Company in Troy, Mich. He is also serving as chairman of the marketing committee for the American Board for Certification in Orthotics and Prosthetics.