Advocates Make Inroads

Updates from Arkansas, Illinois, New York, and Oregon

Each month, State By State features news from O&P professionals about the most important state and local issues affecting their businesses and the patients they serve. This section includes information about medical policy updates, fee schedule adjustments, state association announcements, and more. These reports are accurate at press time, but constantly evolve. For up-to-date information about what is happening in your state, visit the Co-OP at AOPAnet.org/resources/co-op.

Arkansas

Senate Bill (SB) 92, introduced Jan. 23, would set reimbursement for orthotics and prosthetic care under the state Medicaid program to 90% of Medicare. This increase was implemented through regulatory channels by Arkansas Medicaid Jan. 1, but SB 92 would codify the increase into law.

Illinois

Joining a growing list of states focusing on improving access to devices for children, Illinois has introduced So Kids Can Move legislation. In early February, Jim Kaiser, CP, LP, president of the Illinois Society of Orthotists and Prosthetists (ISOP), and other ISOP members worked with Sen. Ann Gillespie and Rep. Will Guzzardi to introduce SB 2195 and House Bill 3036. These identical companion bills mandate coverage of activity-specific orthoses and prostheses in commercial health plans for enrollees of all ages. The So Kids Can Move team is working with ISOP to assist with legislative advocacy efforts.

New York

The New York legislature introduced three O&P bills early in the 2023 session.

SB 3131 directs the New York Commissioner of Health to conduct a study related to New York Medicaid’s reimbursement rate adequacy and patient access. This bill is identical to SB 7023 and Assembly Bill

(AB) 7892, companion bills that were introduced but failed to pass during the 2022 legislative session.

SB 3468 and AB 3408 require that Medicaid managed care organizations reimburse for orthotic and prosthetic care at no less than 100% of traditional Medicaid reimbursement rates. This bill’s Medicaid “floor” requirement is similar to that of Indiana’s HB 1018, discussed in O&P Almanac’s February and March State By State columns.

AB 4395 mandates that individual, group, and inpatient plans in the state provide coverage for prosthetic devices, including repair and replacement, that are intended for medically necessary rehabilitative and habilitative services as required by the Affordable Care Act’s Essential Health Benefits.

Oregon

SB 797, introduced in late January, implements insurance fairness for orthotic and prosthetic devices for enrollees of all ages in private group and individual health insurance plans in the state. Oregon previously enacted insurance fairness through HB 2517 in 2007; however, that bill was repealed in 2017 due to a sunset clause in Oregon statute. The bill’s sponsors, Sen. Sara Gelser Blouin and Rep. Lisa Reynolds, believe that this noncontroversial bill reinstituting a longstanding policy will likely see little resistance.

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