What’s in a Name?

Orthotic and prosthetic activists have fought hard to control the
parity message, working tirelessly to avoid any political
firestorms or buzzwords that divide instead of unite. At the same time, these
advocates, activists and lobbyists are informing individuals and legislators
about the benefits of parity and what it truly means — requiring plans
that cover O&P services to provide those benefits at the same level as
other surgical and medical benefits, with no separate caps, arbitrary
exclusions or lifetime limits for care. If you want to control a bill’s
message, you might as well start at the top. What was once the
Prosthetic and Orthotic Custom Parity Act is now the
Insurance Fairness for Amputees Act.

In front of the message

The word “parity” has long been associated with mental health
parity, according to Peter W. Thomas, JD, general counsel,
National Association for the Advancement of Orthotics and
Prosthetics (NAAOP). Due in part to a controversial mental health debate,
parity gained its detractors and staunch advocates. Some legislators have even
equated parity to a mandate, a divisive word within the halls of Congress that
in many political circles holds a negative connotation.

	Image: © iStockphoto.com

“In the current political environment, Congress will reject
anything that sounds like a mandate,” Ryan Ball, government relations,
Orthotic and Prosthetic Group of America, told O&P Business News.

Changing the bill’s name to the Insurance Fairness for Amputees Act
counters this mischaracterization.

“Part of the reasoning behind the changing of the name was
conceptual,” Thomas told O&P Business News. “The advocates
in favor of prosthetic and orthotic parity legislation wanted to seize on a
word that better conveyed the goal of the legislation. The goal is fairness.
They wanted to ensure that people would not be limited to one prosthesis per
lifetime or a $2,000 cap on O&P devices. It is not fair and it is not how
they treat other benefits.”

The name change is certainly a messaging issue, but it is also to ensure
that consumers and legislators understand the law.

“There are no caps for stroke victims,” Dan Ignaszewski,
government relations coordinator,
Amputee Coalition (the Coalition), told O&P Business
News. “Insurance companies wouldn’t cap their spending at $5,000
or say ‘one stoke per lifetime.’ But that is what amputees face. We
need to eliminate cap restrictions on devices. People must have greater access
to prostheses or orthoses. The cost for insurance companies is minimal, but the
impact is immense.”

Government relations

As of press time, 19 states have successfully passed parity bills, with
Utah being the latest state to sign parity into law in 2010. Eight states
(Connecticut, Delaware, Florida, Idaho, Minnesota, New York, Pennsylvania and
Washington) have introduced Insurance Fairness for Amputees bills this
legislative cycle. Nine more states (Alabama, Michigan, Nebraska, North Dakota,
Ohio, Oklahoma, South Carolina, Tennessee and Wisconsin) are reintroducing the
bill to their state legislators, according to Ignaszewski. At the federal
level, during the 111th Congress, the Prosthetic and Custom Orthotic Parity Act
(H.R. 2575) never made it out of committee, despite racking up 30 cosponsors.
The 111th Congress did little in the way of passing O&P legislation.

On April 8, the Insurance Fairness for Amputees Act (S. 773) was
reintroduced in the Senate. According to the NAAOP, Sen. Olympia Snowe (R-Me.)
and Sen. Tom Harkin (D-Iowa) introduced the bill. A similar bill is expected to
be introduced in the House of Representatives as well.

On June 14, the Delaware House of Representatives unanimously passed its
parity bill (House Bill 76), 38–0. A week later on June 21, the bill
unanimously passed the Delaware Senate, 21–0. As of press time, the bill
is being send to Gov. Jack Markell (D-Del.) for his consideration. The Amputee
Coalition expects Gov. Markell’s signature, which would make Delaware the
20th state to pass the Insurance Fairness for Amputees Act into law.

Although Thomas acknowledges that a bill can gain momentum if other
states follow suit, it is simply too soon to tell, and there are far too many
unknown variables to determine whether passage through the Delaware House and
Senate is the beginning of a momentum shift for the O&P profession, he
said. Ball agreed.

d more
power and spend more money than their counterparts. If insurance companies
oppose a bill, their message is heard loud and clear. O&P associations and
organizations do not have that luxury.

“Government relations is a never-ending battle that requires
constant follow-up and monitoring; advancing a specific piece of legislation is
often times a lengthy process,” Ball said. “On the issue of parity,
we must consider the forces working against our interests, primarily insurance
companies, and understand that education and exposure of our issues helps our
cause tremendously.”

Ball recalled associates fighting just to get in the same room as three
or four major insurance companies and their lobbyists during the fight to get
prosthetic parity passed in Iowa in 2009.

“Our industry’s associations and advocacy groups do a
tremendous job of keeping our story on their radar screens,” Ball said.
“We’re constantly trying to get our message on the top of
legislators’ desks.”

Amputees have stormed the House and Senate in the past with signs that
read “Arms and Legs are Not a Luxury.” The message is exactly what
state and federal politicians can rally around — issues that have a direct
impact on real people.

What is at stake?

When discussing parity and fairness, what O&P advocates are really
talking about is insurance coverage. According to Thomas, a strong showing for
the Insurance Fairness for Amputees Act at the federal level may help the
O&P industry get included in the Essential Benefits Package, which is part
of the Health Insurance Reform portion of the Affordable Care Act. O&P
advocates must demonstrate that the O&P field is an “essential
benefit” and needs to be included in private benefits packages. The
Essential Benefits Package will likely form the minimum insurance plan that can
be sold in the state-based health exchanges starting in 2014.

Secretary of Health and Human Services Kathleen Sebelius is scheduled to
be regulating later this fall on that issue. The regulation will be informed
through reports from the Department of Labor (DOL) and the Institute of
Medicine.

On April 15, the DOL released its findings and analysis regarding
coverage benefits under the typical employer plan once the Affordable Care Act
is implemented in 2014. According to Thomas, the report lacked comprehensive
information on O&P coverage.

“Can you imagine losing a limb in an accident and not getting an
artificial limb as a replacement or O&P care?” Thomas asked.
“That’s just not insurance. We need to make that argument. The fact
that the Fairness Act is in Congress is a great step. The more support we can
get, the more important it will be viewed.”

Thomas insisted there is not a direct correlation between passage of the
Insurance Fairness for Amputees Act and inclusion in the Essential Benefits
Package. Still, a strong showing would make the industry’s voice a little
louder and more difficult for Congressional leaders to ignore.

“It’s a rallying cry to making sure those benefits are
included,” Thomas said.

On May 2, Sen. Barbara Mikulski (D-Md.) sent a letter to Sebelius,
urging her to include the O&P industry in the Essential Benefits Package.

“As your agency works to develop the Essential Benefits Package
— as required by the Patient Protection and Affordable Care Act — it
is imperative that every effort be made to ensure that individuals needing
O&P devices will be able to obtain them,” Mikulski wrote.

Licensure: Small victories, tough defeats

According to the American Academy of Orthotists and Prosthetists’
Orthotic and Prosthetic Licensure: A Comprehensive Guide, licensure
requirements are in the best interests of the profession because they give
“official status to the practice of the profession, establish a recognized
scope of practice for orthotists and prosthetists and will be recognized by
other health care practitioners in the crossover of patient care
responsibilities.”

Like parity, no state has passed a licensure bill this year. Licensure
brings a level of professionalism to the O&P industry. In unlicensed
states, the O&P industry is likely one of the few health care providers not
licensed. Licensure also brings a level of assurance and accountability for
O&P practitioners, as well as an added protection for the patient.

In March, Iowa’s O&P state licensure bill (S.F. 364) passed the
state Senate with a bipartisan vote of 37–12. Unfortunately, the bill
failed to make it out of the state House of Representatives. According to Ball,
at issue was the $40,000 cost associated with the initial start of the board.
The O&P Licensure Board integrated with the state Board of Podiatry to save
costs for Iowa. It was not enough. A vote on S.F. 364 was blocked, effectively
killing the bill for this year.

“One of the reasons why the bill stalled was because it got caught
up in the partisan politics of spending,” Ball said. “We have to be
persistent. We must learn from our mistakes. This is what happened. Let’s
figure out what works and what does not and move on. We will make contacts,
follow up with them and pick it up next year.”

	Eileen Levis

Eileen Levis, president, Pennsylvania O&P Society
(POPS) knows exactly what Ball is feeling. In November 2009, Levis talked with
O&P Business News about her 5-year struggle to get licensure passed
in Pennsylvania. The political climate in which she worked, along with board
freezes, made it difficult for the bill to move through the Pennsylvania
legislature.

More than 20 months later, Levis is still in the midst of the pursuit
— and making significant progress, thanks to a change in the Pennsylvania
political climate. The sponsor of the bill, Rep.Mario Scavello (R-Pa.), is now
looked on favorably by state legislators, according to Levis, which has
increased the likelihood of the bill’s passage. On May 2, the Pennsylvania
state licensure bill (H.R. 48) passed the state House by a vote of 174–20.

“It is going to be introduced into the Senate,” she said.
“There is no opposition to the bill that we know of and it should fly out
of the Senate. We are hoping it will pass this session; if not, then hopefully
by the end of the year. The next step is Gov. Tom Corbett (R-Pa.) will sign it
into law and then we will work on establishing a licensure board. There will be
a lot of work ahead.”

A continuous process

Terry Supan, CPO, FAAOP, FISPO, president and chief executive officer,
Supan Prosthetic Orthotic Consultations, a veteran of the licensure process,
suggested researching the information that is already on the Web or through
phone calls with people who have or are currently working through the political
gauntlet like Levis and Ball.

	Terry Supan

“The biggest recommendation I could give is that interested parties
need to plan on having a lobbyist involved in the process,” Supan told
O&P Business News. “Lobbyists can be expensive, but the more
you have done ahead of time for them, the more you are going to save. Still,
lobbyists can help you navigate through the processes so you do not get lost in
the shuffle.”

Levis had the same lobbying group for several years. and as time moved
on, their visions began to differ. This year, POPS retained former Gov. Tom
Ridge’s lobbying firm, the Ridge Policy Group. The combination of a change
in political climate as well as a change in POPS’s lobbying firm had a
significant impact on the bill’s passage. The connections of the new
lobbying group, as well as the respect it garnered, shined a new light on the
bill.

“The process was a continuum,” Levis said. “The process
evolved as time went on, and there were a number of unforeseen variables in
Pennsylvania. During one of the years, there was an absolute freeze in
establishing new licensure boards. So we were up against the wall. It was a
long winding road rather than a series of starts, stops and redos.”

Luckily for the industry, O&P is a feel-good piece of legislation.
Lobbyists have a narrative that strikes members of both sides of the aisle and
in both houses of government.

“You are doing something for people who are already
disadvantaged,” Supan said. “It is pretty easy to sell that to the
legislature.”

Consumer power

To sell the message, advocates, patients, practitioners and supporters
must take the time to email or call their congressional leaders, according to
Thomas. Follow-up phone calls from advocacy groups as opposed to a single
individual can make a greater impact.

“People don’t know the power they really have,” Thomas
said. “In this day in age, everyone is picking up the phone and calling
their congressman or congresswoman. It’s important for groups of people to
contact their congressional leaders and talk about these bills in order to get
some traction. You can’t make one phone call and be done with it. Often,
it takes some involvement in the political process.”

When meeting with legislators, Ball knew he was just one of perhaps as
many as 15 meetings that day. He needed to make his presence felt. He needed to
be memorable.

Thomas suggested visiting the congressman or congresswoman when they are
at their offices or events that they may hold. Schedule meetings or attend
dinners that the legislator is also attending. Become a recognizable face.
Perhaps an O&P practitioner can even invite the legislator to their
facility to show them what O&P care is all about, he suggested.

“I can see why it can be daunting to call your congressional leader
and expect him or her to automatically jump on board,” Thomas said.
“But that is how it’s done.” — by Anthony Calabro

For more information

• American Academy of Orthotists and Prosthetists. O&P
  Licensure: A Comprehensive Guide. Available at:
  www.oandp.org/assets/upload/Licensure-Toolkit.pdf. Accessed
  June 29, 2011.
• Calabro A. Roadblocks to licensure. O&P Business News.
  2009;18(21):16-18.
• O&P Makes Licensure Gains in Pennsylvania. AOPA in
  Advance. 2011;15(10).
• Pavlou S. Prosthetic parity: In the midst of health care reform.
  O&P Business News. 2010; 19(9):13-20.
• Sen. Mikulski (D-Md.) sends letter to HHS on behalf of O&P as
  an ‘Essential Health Benefit.’ AOPA in Advance. 2011;15(10).