State by State
The latest news from Connecticut, Illinois, Michigan, Minnesota, and Pennsylvania
Each month, we talk to O&P professionals about the most important state and local issues affecting their businesses and the patients they serve. This column features information about medical policy updates, fee schedule adjustments, state association announcements, and more.
After insurance fairness legislation passed both houses of the Connecticut state legislature, Gov. Dannel P. Malloy signed the bill into law with a written warning to the legislature advising against the passage of unfunded mandates, stating, “We must proceed cautiously when taking legislative action that may put vital health insurance out of reach for low-income and middle-income individuals in our state.”
Local advocates Herb Kolodny and Brenda Novak continue their outreach efforts, with a new mission to inform and educate the Connecticut limb loss community about the new law through their organization, the Connecticut Amputee Network.
O&P providers in Illinois have reported that Blue Cross Blue Shield of Illinois is denying pre-authorizations based on the absence of terminology distinguishing “permanent” from “preparatory,” requiring the term “permanent” to be present. Standard language across the profession would distinguish a preparatory prosthesis from a definitive prosthesis, rather than using the term “permanent.”
A poll has been added to the Illinois page of the AOPA Co-OP to solicit feedback from Illinois providers regarding this issue.
Two insurance fairness bills have been introduced in Michigan. Rep. Peter Lucido (R-District 36) introduced House Bill 6009 on May 16, 2018. Shortly after, Rep. Beau LaFave (R-District 108) introduced House Bill 6085. If passed, either bill will amend Act 218 of the Pennsylvania Insurance Code of 1956 to require coverage of prosthetic and orthotic devices and services.
“The Amputee Coalition is working with both offices to bring the bills and sponsors together and [is] thankful to patient and professional advocates who have made significant strides this year in raising awareness about the need for this legislation in Michigan and getting it introduced,” said Dan Iganzsweski, director of government affairs for the Amputee Coalition.
After extensive conversations between O&P providers and Minnesota Medicaid regarding the Minnesota Health-Care Programs fee schedule, an agreement was reached to increase reimbursement of S1040—cranial molding orthoses—to an allowable of $2,782.80. The fee schedule increase, retroactively effective Jan. 1, 2018, represents a significant win for Minnesota O&P providers and signals an opening for continued partnership with Minnesota Medicaid to ensure access to O&P services for the O&P patient population.
Pennsylvania O&P providers and the Pennsylvania Orthotic and Prosthetic Society are working with the Amputee Coalition on language for an insurance fairness bill with hopes for introduction in 2019.
Editor’s Note: To submit an update for publication, please email awhite@AOPAnet.org. For up-to-date information about what’s happening in O&P in your state, visit the AOPA Co-OP and join the conversation in the AOPA Google+ Community.