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APPLL
UPDATE

Prosthetic Parity
What's Going On in Your State?

The ACA Defines Prosthetic Parity As Insurance Companies Covering Appropriate Prosthetic Care

by Leslie Duncan

While the ACA will work to change federal laws related to prosthetic reimbursement, we are currently working with groups that are, or will be, trying to enact legislation to ensure that state-mandated insurance companies reimburse for prostheses.

In the last four years, Colorado (2001), Maine (2003), and New Hampshire (2004) have passed prosthetic parity laws. California, Connecticut, Massachusetts and New York are in the process of introducing bills to their legislatures. New Jersey, Washington, Ohio, Louisiana and Alabama are in the beginning stages of their parity efforts.

State Parity Efforts

California
In California, bill AB 976 was pulled from the insurance committee and was not heard, as originally scheduled, on April 12. According to committee rules, all bills that create a new mandate for coverage face a mandatory evaluation by the University of California before they can be heard.

Sherri Daley, who works with the California Orthotics& Prosthetics Association (COPA), explains: “This requirement is by statute; thus, we cannot get a waiver by our rules committee to move forward. This does not make the bill a ‘study bill,’ as it will remain intact while the evaluation is completed and then move forward. The only good news here is that we will include the adult population so that we are prepared to amend the bill to restore it to a more comprehensive coverage bill.”

Massachusetts
Keith Cornell, CP, is heading the parity effort in Massachusetts.“In Massachusetts, we are working as diligently as we can and making slow progress,” he says. “Our bill got a number for the new session; it is H837.”

The Massachusetts group has also planned an event at the Statehouse on May 23, and they hope that many people will attend to showcase the need for the bill and to touch as many members as possible.

“We continue to have weekly conference calls, and our lobbyist has arranged for us to meet with MAHP (Massachusetts Association of Health Plans) to discuss any issues they have with the bill and work them out,” Cornell says. “That’s key if we expect to move on the bill.”

A report, a review and evaluation of the Massachusetts parity bill with reference to its fiscal impact on the state, has been published by the Massachusetts Joint Committee on Financial Services. It appears very promising with good statistics and an estimated average five-year cost of 41 cents/year per member covered.

“That’s even lower than our predictions,” Cornell says. “We frankly had to work very hard and meet with the House insurance chair several times before the bill was sent over to be studied.”

Connecticut
Elizabeth Mansfield in Connecticut says that the insurance committee did not vote to bring the Connecticut bill to the floor and that they will now be attempting to add parity language as an amendment to health-insurance-related bills on the floor of the House and the Senate.

New York
According to ACA President & CEO Paddy Rossbach, New York assembly bill A00450 is currently being reviewed by the insurance committee.

Elizabeth Mansfield
Elizabeth Mansfield represents the ACA at national, regional and state events to build awareness of the ACA’s Action Plan for People with Limb Loss (APPLL) and public health issues facing amputees.

Mansfield, who is also president of Outsource Marketing Solutions, LLC, is actively involved in OPLAN (O&P Legislative Action Network) and is responsible for initiating the prosthetic parity legislation effort in Connecticut. She has a degree in communications from Boston College and was president and CEO of Altman Prosthetic and Orthotic Center from 1996 to 2001.

Mansfield can be reached by phone at 570/357-4416 or by e-mail at outsourcemarketing@sbcglobal.net

Back to Top	Last updated: 08/09/2008