Health Care Reform Debate Treats O&P and DME Separately

Health Care Reform Debate Treats O&P and DME Separately

NAAOP

8/18/2009

Health Care Reform Debate Treats O&P and DME Separately

Of the many issues to report in the current debate in Congress over health
care reform, it has become clear that the O&P benefit is being treated
separately from durable medical equipment. There are several examples that
illustrate this separate treatment and, because this has been a
long-standing goal of NAAOP and the O&P profession, these examples are
highlighted below. However one feels about the health care reform bills
emerging from Congress, it is heartening to know that to date, leaders in
Congress finally appear to understand that DME and O&P are separate and
distinct, and should be treated differently for policy purposes. This comes
after many years of education of policymakers by NAAOP and other O&P
organizations. While the O&P profession must remain vigilant, it is an
encouraging sign.

1. Separate Coverage in Essential Benefits Package: One measure of the
separate treatment of DME and O&P can be seen in the health care reform
legislation passed out of the House Education and Labor Committee in late
July. The leadership of this committee addressed the concerns of NAAOP,
Alliance organizations, and disability groups by clarifying that all private
health plans that participate in a new Health Insurance Exchange must
cover assistive devices for people with disabilities. In the past, it was
typical for Congress to have simply included a specific reference to
durable medical equipment, assuming that orthotics and prosthetics would
be included within the confines of that term. However, the Committee bill
states in statute that durable medical equipment, prosthetics, orthotics
and supplies are considered essential benefits under all private health
insurance plans offered under the Exchange. Not only does this language
make it clear that O&P benefits are covered, but it draws an explicit
distinction between these benefits and durable medical equipment.

2. O&P Spared by Amendment that Cuts DME Fee Schedule: On the last day of
the House Energy and Commerce Committee's mark-up of health reform
legislation, an unexpected amendment was offered to improve cancer treatment
and reimbursement under the Medicare program. To help pay for the cost of
these changes, an offset was proposed that would reduce the annual CPI-U
increase to the Medicare DME fee schedule by one half of one percent (.5%)
each year for the next four years. The amendment passed and the amendment
was added to the underlying health reform bill reported out of the Energy &
Commerce Committee. While this is bad news for DME suppliers and will
likely be aggressively fought by that field, the reduction in reimbursement
does not apply to the O&P fee schedule. This is largely due to the fact
that the Medicare statute lists the O&P benefit in a separate place from the
DME benefit. O&P is separate and distinct from DME in the law and the
legislation adopted by the Energy & Commerce Committee recognized that fact.
The Committee did not automatically assume that DME includes O&P, and this
separate treatment accrued to the benefit of the O&P profession.

For a profession that has long sought separate and distinct treatment from
policymakers, these developments offer significant evidence that the
advocacy efforts of NAAOP and the Alliance organizations over the past
decade or more are having the desired effect.

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