Help Secure Coverage of O&P in State Essential Health Benefit Packages!
NAAOP has been hard at work during the last several months addressing the inclusion of orthotics and prosthetics in the Essential Health Benefit (EHB) packages being developed by the states. Last December, the Secretary of Health and Human Services opted not to create a federal EHB package but, instead, provided guidance to states to develop their own benefit designs. Many states are currently actively developing these benefit packages and refining them to comply with federal law.
Now is the time for NAAOP members and friends to advocate at the state level to help ensure appropriate coverage for orthotics and prosthetics in your states’ EHB package.
Lead by NAAOP and the O&P Alliance, a comprehensive state “technical assistance” document has been developed and has gained the support of over fifty national, non-profit, disability and rehabilitation organizations. These patient and provider organizations have endorsed a detailed explanation of the federally mandated category of benefits referred to as “rehabilitative and habilitative services and devices.” The document discusses orthotic and prosthetic coverage in depth and makes a strong case for inclusion of these benefits in state EHB packages. This consensus document can be viewed and downloaded from the NAAOP website at www.naaop.org.
We encourage all NAAOP members and friend to visit our website, download this document, review the accompanying sample documents to assist you with advocating to your state policy makers, and engage in the process of advocacy at the state level on this critical issue. There is ample evidence from the Affordable Care Act’s legislative history and from the inclusion of O&P care in many existing small group health plans that O&P services and devices should be included in the state EHB packages. However, states have discretion to include or exclude benefits and a strong showing from the O&P profession and the patients we serve will help increase the likelihood of coverage of O&P care in the future.
While some states have already selected a benchmark EHB plan, many states are in the process of refining those initial selections and some states have been considerably delayed in making their selections. In addition, states are required to update the contents of their benefit packages in future years. With this in mind, NAAOP hopes the state technical assistance document it helped draft, and whole-heartedly supports, will constitute an important tool for the O&P field for months and years to come. If you have any questions regarding this EHB initiative, please contact: firstname.lastname@example.org.