The U.S. House Passes Healthcare Reform: Mixed Bag for O&P Emerges

The U.S. House Passes Healthcare Reform: Mixed Bag for O&P Emerges

NAAOP

11/10/2009

The U.S. House Passes Healthcare Reform: Mixed Bag for O&P Emerges

The U.S. House of Representatives voted by a slim margin of 220 to 215 to
pass a massive healthcare reform bill on Saturday, November 7th. Entitled
the Affordable Health Care for America Act, H.R. 3962 includes provisions
that impact the O&P profession in positive ways, but reconciling the bill
with the Senate version will bring several challenges to the O&P field.

The House legislation would provide private insurance for over twenty five
million without current coverage and includes a modified public insurance
option that would utilize negotiated provider reimbursement rates (rather
than Medicare rates), allowing states to establish their own public option
rather than relying on a national one. The bill significantly expands
Medicaid eligibility to 150 percent of the federal poverty level (FPL),
compared with 133% in the original House bill and in the Senate legislation.
The bill also creates health insurance exchanges which would serve as new
web-based marketplaces to shop and compare private insurance plans,
establishes new consumer protections in the sale and premium rating of
private insurance, and provides federal subsidies to low income individuals
and families to help purchase coverage.

Coverage of Orthotics and Prosthetics in Private Insurance: Notably, the
House bill specifically recognizes coverage of orthotics and prosthetics in
the essential benefits package that all private health insurance plans must
cover if they operate under the new health insurance exchanges. This is a
major improvement to the House bill from the original version in June which
did not include coverage of O&P care and demonstrates that strong and
persistent advocacy can achieve results in Washington.

Protecting the O&P Fee Schedule: To offset the cost of covering 25 million
uninsured persons, Congress has proposed to impose a series of reimbursement
cuts to providers if the bill is implemented, including the inclusion of new
productivity adjustments in the market basket used to set annual updates
for a wide range of providers. Considering the fact that almost every
provider group, except physicians, is slated to have their updates reduced
in this bill, including durable medical equipment, the O&P field fared well
in the House legislative process. The House bill does not cut or reduce O&P
CPI updates, nor does it impose productivity adjustments.

While the House bill's productivity adjustments do not impact the orthotic
and prosthetic fee schedule, the Senate Finance Committee provisions do. The
Senate bill would permit annual CPI updates to the O&P fee schedule to be
reduced by a factor based on productivity and efficiency of providing
health care. In other words, the Medicare program's fee schedules will be
adjusted downward by amounts determined to correspond to the increases in
efficiency in the general economy. The link between these two factors is
highly suspect and NAAOP and its Alliance partner organizations will be
monitoring this closely and advocating over the coming weeks and months to
protect the integrity of the O&P fee schedule during healthcare reform.

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