Yesterday, NAAOP issued the following alert to all state Governors, COVID-19 State Task Forces, and Health Insurance Commissioners. The alert makes clear that during the COVID-19 national emergency, state and local health authorities should consider orthotic and prosthetic practices as essential providers that must remain accessible to patients in need of orthotic and prosthetic care during this pandemic. NAAOP is taking this step in response to a number of O&P practitioners in states that are contemplating shutting down “non-essential” health care providers.
Based on member feedback, NAAOP today issued this revised statement clarifying that prosthetic and orthotic practitioners should triage patients to treat those with the most urgent needs and postpone non-urgent care in the interests of patient and practitioner safety.
Please feel free to distribute this statement to anyone you think should see it.
March 20, 2020
VIA ELECTRONIC DELIVERY
ALL STATE GOVERNORS
COVID-19 STATE TASK FORCES
HEALTH INSURANCE COMMISSIONERS
RE: Prosthetic and Orthotic Care is an Essential Health Benefit that Patients Must Have Access to During the Response to the COVID-19 Pandemic
Americans in urgent need of prosthetic limbs and orthotic braces must be permitted to access orthotic and prosthetic care during the COVID-19 pandemic. These services are essential health benefits as defined by the Patient Protection and Affordable Care Act (ACA) and should be treated by the federal, state and local governments as necessary health care services, providers of which should remain accessible to provide orthotic and prosthetic (O&P) care to patients in need. To reduce the risk of infection, federal, state and local governments should issue further guidance and safety protocols to minimize transmission of the virus during patient care encounters. O&P practitioners should triage patients to serve those most in need and seek to postpone non-urgent treatments until the threat decreases.
On March 18, 2020, the White House Task Force on COVID-19, in conjunction with the Centers for Medicare and Medicaid Services (CMS), issued recommendations on adult elective surgery and non-essential procedures. The recommendations stated that all adult elective surgeries as well as non-essential medical, surgical, and dental procedures should be delayed during the COVID-19 outbreak. The guidance stipulated that such decisions remain the responsibility of local healthcare delivery systems, including state and local health officials.
The guidance also stated that when making these decisions, state and local authorities should consider not only the clinical situation but resource conservation of personal protective equipment, hospital beds, and availability of ventilators. (The provision of prosthetic and orthotic care does not impact the availability of hospital beds or ventilators.)
The National Association for the Advancement of Orthotics and Prosthetics (NAAOP), a national organization focused on the advancement of prosthetic and orthotic care, stands ready to assist the federal, state and local governments as they implement measures to minimize the risk of COVID-19 infection, but potentially eliminating all access to prosthetic and orthotic professionals as non-essential would not be prudent and would result in many patients having their urgent prosthetic and orthotic needs go unmet.
The White House/CMS recommendation defines as Tier 3b surgical services that should not be postponed, including surgeries due to trauma as well as limb threatening vascular surgery. These are medical procedures that require immediate post-operative (and in some cases, pre-operative) prosthetic and/or orthotic care in order to achieve appropriate patient outcomes. Other examples of the need for continued access to prosthetic and orthotic professional services include:
- Infants and toddlers with Plagiocephaly in need of cranial orthotic “helmets;”
- Children with severe scoliosis, cerebral palsy or other congenital disabilities that require orthotic bracing or prosthetic limb care;
- Survivors of limb loss due to vascular disease and trauma but also other reasons such as cancer and other diagnoses;
- Orthotic treatment to assist in treating low back pain, spinal fractures, joint disease, and other conditions that affect the ability to walk and remain functional without significant pain; and,
- Limb loss as a result of complications from diabetes.
In these and other urgent situations, the timeliness of prosthetic and orthotic care, as part of the rehabilitation plan of care, is instrumental to patients in achieving positive functional outcomes without unnecessary complications. We strongly urge the federal, state and local governments to continue to permit access to essential prosthetic and orthotic clinical care during the response to the COVID-19 outbreak and welcome the opportunity to work with state and local decision-makers to develop more specific guidance to keep patients and providers safe during O&P treatment. We also encourage O&P practitioners to triage patients to serve those most in need and postpone treatments that can be safely postponed until the threat of infection is reduced. We look forward to working with state leaders as the trajectory of this pandemic evolves and seek to maximize patient safety in this process.
Thank you for your consideration of this recommendation and please contact Peter W. Thomas, NAAOP General Counsel, at Peter.Thomas@powerslaw.com or 202-607-5780 if you have any questions.
Glenn Crumpton, LPO
Section 1302 of the ACA (42 U.S.C. 18001) defines ten essential health benefits, including “rehabilitative and habilitative services and devices.” This benefit category clearly includes coverage of prosthetic and orthotic care as defined by the Summary of Benefits and Coverage, and consistent with both the Institute of Medicine report on Essential Health Benefits and Congressional intent expressed during passage of the ACA itself. See
IOM (Institute of Medicine). 2012. Essential Health Benefits: Balancing Coverage and Cost
. Washington, DC: The National Academies Press; See
111 Cong. Rec. H1882 (daily ed. Mar. 21, 2010) (statement of Rep. George Miller).