NY reverses limitation on prosthesis coverage

New York State has eliminated its “one limb per life” restriction effective Jan. 1, 2016.

According to a press release from the National Association for the Advancement of Orthotics and Prosthetics (NAAOP), Donna Frescatore, executive director of New York’s health insurance exchange, has ordered the elimination of a restriction limiting adult amputees in New York to one prosthesis per limb per lifetime.

A letter from Frescatore to Assemblyman Kevin Cahill, chair of the New York State Assembly’s Insurance Committee, states: “New York’s benchmark plan will be modified starting on Jan. 1, 2016, to include coverage for the cost of repair and replacement of external prosthetic devices for both adults and children. The NY State of Health 2016 Health Plan Invitation will be amended to include this coverage requirement for the individual and small group marketplaces starting with benefit year 2016.”

The letter comes after an online petition against the restriction gained more than 15,000 supporters, according to the release.

“This is a great result for amputees in New York State — it could not have turned out any better,” Dan Bastian, CPO, an above-knee amputee and New York prosthetist who spearheaded bipartisan discussions on the topic with members of the New York State Assembly and Senate said in the press release.

“Not only does the order reverse a coverage limitation that clearly violates the Affordable Care Act, but equally important, the executive director acknowledged that a recent federal regulation requiring coverage for rehabilitative and habilitative devices includes prosthetic limb coverage,” Peter Thomas, general counsel for the NAAOP, said in the release. “This sets an important precedent and provides amputees an important argument against restrictions in other states where [prostheses] have been excluded from coverage entirely in plans offered through those insurance exchanges.”

Reference: www.naaop.org.

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