PRESS RELEASE - NY Reverses Limitation on Prosthetic Coverage - "One limb per life" restriction eliminated effective Jan. 1, 2016
NAAOP
Description
Collection
Title:
PRESS RELEASE - NY Reverses Limitation on Prosthetic Coverage - "One limb per life" restriction eliminated effective Jan. 1, 2016
Creator:
NAAOP
Date:
5/21/2015
Text:
PRESS RELEASE
May 21, 2015
NY Reverses Limitation on Prosthetic Coverage
One limb per life restriction eliminated effective Jan. 1, 2016
Responding to pressure from amputees, prosthetists and politicians, the
Executive Director of New York's health insurance exchange, Donna
Frescatore, has ordered the elimination of a restriction limiting adult
amputees in New York to only one prosthesis per limb per lifetime. In a
letter to Assemblyman Kevin Cahill, Chair of the New York State Assembly's
Insurance Committee, Ms. Frescatore confirmed that:
New York's benchmark plan will be modified starting on January 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.
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, declared the result a total victory for amputees
in New York State. Peter Thomas, General Counsel for the National
Association for the Advancement of Orthotics and Prosthetics (NAAOP), which
coordinated the NY effort agreed, noting that 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. This sets an important precedent
and provides amputees an important argument against restrictions in other
states where prosthetics have been excluded from coverage entirely in plans
offered through those insurance exchanges.
The New York policy change marks the culmination of three months of
intensive work and collaboration between New York prosthetists, patients,
NAAOP, and other disability rights organizations, including the Amputee
Coalition, to educate both the public and New York legislators about the
one-limb-per-life restriction. An online petition drew over 15,000
supporters and a legislative and agency-specific campaign resulted in
victory. NAAOP President David McGill, who strategized with the group and
participated in meetings with New York legislators noted that the New York
victory proves that by combining the resources and intellectual capital of
NAAOP with the efforts of highly engaged and motivated individuals like Dan
Bastian and other local supporters, you can directly improve the lives of
all amputees by providing them access to appropriate prosthetic care and
treatment.
Bastian expressed both happiness and relief with the outcome. We were up
against a June 1 deadline, he said. After that, New York might not have
been able to order changes to the benchmark until plan year 2017. So this is
a great result for amputees in New York State - it could not have turned out
any better.
Please visit our website at: www.naaop.org
NAAOP
1501 M Street, NW
7th Floor
Washington, DC 20005-1700
e-mail: <Email Address Redacted>
(800) 622-6740
(202) 624-0064 Phone
(202) 785-1756 Fax
www.naaop.org
May 21, 2015
NY Reverses Limitation on Prosthetic Coverage
One limb per life restriction eliminated effective Jan. 1, 2016
Responding to pressure from amputees, prosthetists and politicians, the
Executive Director of New York's health insurance exchange, Donna
Frescatore, has ordered the elimination of a restriction limiting adult
amputees in New York to only one prosthesis per limb per lifetime. In a
letter to Assemblyman Kevin Cahill, Chair of the New York State Assembly's
Insurance Committee, Ms. Frescatore confirmed that:
New York's benchmark plan will be modified starting on January 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.
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, declared the result a total victory for amputees
in New York State. Peter Thomas, General Counsel for the National
Association for the Advancement of Orthotics and Prosthetics (NAAOP), which
coordinated the NY effort agreed, noting that 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. This sets an important precedent
and provides amputees an important argument against restrictions in other
states where prosthetics have been excluded from coverage entirely in plans
offered through those insurance exchanges.
The New York policy change marks the culmination of three months of
intensive work and collaboration between New York prosthetists, patients,
NAAOP, and other disability rights organizations, including the Amputee
Coalition, to educate both the public and New York legislators about the
one-limb-per-life restriction. An online petition drew over 15,000
supporters and a legislative and agency-specific campaign resulted in
victory. NAAOP President David McGill, who strategized with the group and
participated in meetings with New York legislators noted that the New York
victory proves that by combining the resources and intellectual capital of
NAAOP with the efforts of highly engaged and motivated individuals like Dan
Bastian and other local supporters, you can directly improve the lives of
all amputees by providing them access to appropriate prosthetic care and
treatment.
Bastian expressed both happiness and relief with the outcome. We were up
against a June 1 deadline, he said. After that, New York might not have
been able to order changes to the benchmark until plan year 2017. So this is
a great result for amputees in New York State - it could not have turned out
any better.
Please visit our website at: www.naaop.org
NAAOP
1501 M Street, NW
7th Floor
Washington, DC 20005-1700
e-mail: <Email Address Redacted>
(800) 622-6740
(202) 624-0064 Phone
(202) 785-1756 Fax
www.naaop.org
Citation
NAAOP, “PRESS RELEASE - NY Reverses Limitation on Prosthetic Coverage - "One limb per life" restriction eliminated effective Jan. 1, 2016,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 24, 2024, https://library.drfop.org/items/show/237381.
