NAAOP: Future of Affordable Care Act remains unclear

Although efforts to repeal and replace the Affordable Care Act have stalled, the future of the health care law remains unclear, according to Peter Thomas, JD, general counsel for the National Association for the Advancement of Orthotics and Prosthetics.

“The bottom line is that there is still a strong interest in moving forward to repeal and replace the Affordable Care Act (ACA), but the conservatives and the moderate Republicans have not been able to come to an agreement,” Thomas said in a YouTube address to association members. “Of course, the Democrats oppose major changes to the ACA. They are willing to move forward with tweaks and changes to the law to improve it, but they do not want it removed. So, we are at an impasse.”

According to Thomas, the National Association for the Advancement of Orthotics and Prosthetics (NAAOP)’s major concern with the proposed Republican health care bill, the American Health Care Act (AHCA), was a provision that would have repealed the essential health benefits package for Medicaid expansion populations. Currently, the health benefits package includes rehabilitative and habilitative services and devices.

“This statutory language, coupled with the regulations that interpret the statute, was instrumental in securing coverage of O&P care across the country in both Medicaid expansion states and ACA individual insurance plans,” David McGill, JD, NAAOP president, said in a NAAOP capitol hill update. “As negotiations on the AHCA continued before its ultimate demise, there were tentative agreements to extend the repeal of the [essential health benefits] EHB from Medicaid expansion states to private plans as well. But with the bill’s failure, EHB dodged a bullet.”

The NAAOP also updated members on a proposed CMS rule that would specify the requirements and qualifications needed for suppliers of custom-fabricated orthotic devices. According to Thomas, more than 5,000 people and organizations commented on the proposed regulation.

According to the update, the rule interprets Section 427 of the Benefits Improvement and Protection Act (BIPA) of 2000, which states no payment shall be made by the Medicare program to any practitioner or supplier of custom orthotics or prosthetics who is not qualified to provide an appropriate level of care. The NAAOP had submitted comments in support of the rule, but said changes should be made before final approval.

“NAAOP will be working in concert with the O&P Alliance to continue to engage CMS to publish a final regulation at the earliest possible time,” McGill said in the update. “However, with the Trump administration’s regulatory relief initiative, we have a stiff headwind in our efforts to secure a final rule.”

The NAAOP also altered its membership of a recently revised protocol from a contractor of the Agency for Healthcare Research and Quality, which addresses the evidence base for lower limb prostheses, according to the update. The revised protocol, “Error Rate Reduction for Lower Limb Prostheses,” seeks information from researchers on evidence that answers a series of research questions.

“A new protocol was just published that has adopted a number of comments that NAAOP and the O&P Alliance submitted back in December, so we are feeling good about that,” Thomas said. “They will look at a lot of additional studies in this review that they would not have otherwise looked at had they not accepted our comments. However, we do not know where exactly this is going, and we do not know exactly how this interacts with the interagency committee on lower limb prostheses, which is examining some of these same issues. We will be submitting comments again on this revised protocol.”


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