Major Policy Priorities Confront O&P

Major public policies that impact orthotics and prosthetics were in play during the month of March including the following:

1. ACA Repeal and Replace Falters:  House Republicans were unable to bridge differences between their conservative and moderate factions on the ACA repeal and replace legislation known as the American Health Care Act (AHCA).  All Democrats opposed the bill.  This resulted in the bill being pulled from the House floor before a vote was taken.  The bill is indefinitely on hold and the Senate is not likely to take up health reform any time soon.  NAAOP’s major concern with the AHCA centered on preservation of access to orthotic and prosthetic care.  The bill would have repealed the essential health benefits (EHB) package for Medicaid expansion populations, which currently includes coverage of “rehabilitative and habilitative services and devices.”  This statutory language, coupled with the regulations that interpret the statute, was instrumental in securing coverage of O&P care across the country in both Medicaid expansion states and ACA individual insurance plans.  As negotiations on the AHCA continued before its ultimate demise, there were tentative agreements to extend the repeal of the EHB from Medicaid expansion states to private plans as well.  But with the bill’s failure, EHB dodged a bullet.  Ultimately, health reform is not over.  The threat to O&P coverage will continue, especially through the regulatory process.  But for the time being, the effort to repeal and replace the Affordable Care Act is in disarray.

2. BIPA Section 427 Proposed Rule:  Over 5,000 individuals and organizations commented on the proposed regulations interpreting Section 427 of the Benefits Improvement and Protection Act (BIPA), which were due on March 13th.  This regulation would implement the statutory provision enacted in the year 2000 that would limit  Medicare payment for custom orthotics and prosthetics only to qualified practitioners and suppliers.  Much of the proposed rule defined exactly which health care professionals will be considered qualified and which will not.  NAAOP will be working in concert with the O&P Alliance to continue to engage CMS to publish a final regulation at the earliest possible time.  However, with the Trump Administration’s regulatory relief initiative, we have a stiff headwind in our efforts to secure a final rule.

3. AHRQ Issues Revised Protocol for Lower Limb Prosthetic Evidence Base:  A contractor of the Agency for Healthcare Research and Quality (AHRQ) recently released a revised “protocol” addressing the evidence base for lower limb prostheses.  The revised protocol ominously entitled, “Error Rate Reduction for Lower Limb Prostheses,” seeks information from researchers on evidence that answers a series of research questions.  The revised protocol adopted many comments drafted by the O&P Alliance, in which NAAOP participated.  Therefore, far more studies will be considered relevant under the new study protocol.  More information will be distributed when it becomes available.