State By State

Expanding Coverage

Updates from Illinois, Kentucky, Maine, Pennsylvania, and Virginia

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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 www.AOPAnet.org/resources/co-op.

Illinois

After several meetings with state lawmakers in early 2022, a proposal by the Illinois Society of Orthotists and Prosthetists (ISOP) to add 58 L codes to the Medicaid fee schedule has obtained budget approval. Reimbursement for these new codes, which include myoelectric and other high-tech components, will be set at 2022 prevailing Medicare rates minus 6%. ISOP and the Illinois Department of Healthcare and Family Services will work together to implement these fee schedule changes. For a detailed rundown of the approved proposal, visit the Illinois page of the AOPA Co-OP.

Kentucky

The Kentucky legislature has introduced coverage mandate legislation, HB 713, which requires that state insurance plans provide coverage at least equivalent to Medicare. In addition, state insurance plans issued to public employees are required to provide access to providers that practice O&P, as well as at least two distinct O&P practitioners. For more information, visit the Kentucky page of the AOPA Co-OP.

Maine

Maine has passed HP 741 into law. The law mandates that, for enrollees under age 18, state insurance plans must cover an additional prosthetic device that is intended for recreational purposes, such as running, swimming, or biking. In April of 2021, AOPA took part in a Health Coverage, Insurance, and Financial Services Committee hearing in support of the bill. To read the enacted version of the bill, visit the Maine page of the AOPA Co-OP.

Pennsylvania

HB 2605, a bill mandating coverage for prosthetic devices, repair, and replacement in state insurance plans, has been introduced in the Pennsylvania legislature. Several legislators have indicated support for the bill, which garnered 15 cosponsors just days after its introduction May 20. This success may be attributed to the bill’s predecessor, SB 289, which was introduced in early 2021 but failed to pass out of committee despite considerable support. To learn more, visit the Pennsylvania page of the AOPA Co-OP.

Virginia

HB 925 and SB 405, identical companion bills mandating prosthetic coverage in state insurance plans, have been passed into law, effective July 1, 2022. For details, see the Virginia page of the AOPA Co-OP page.

Trust, Move, Live.

Since the introduction of C-Leg and its groundbreaking control technology, Ottobock has never stopped inventing new ways to take your patients as far as they want to go. With a portfolio including the Kenevo, Genium, X3, and now the latest iteration of C-Leg 4, every microprocessor knee supports a journey toward a limitless future.

Kenevo

IP 22

The Kenevo is designed specifically for users with mobility limitations who need a high level of stability. State-of-the-art technology allows users to feel safer and more independent in their everyday life.

An IP 22 rating protects from dripping water or dust. C-Leg 4

IP 67

The C-Leg 4 provides exceptional reliability and dynamically adapts to a wide variety of everyday situations. The legacy lives on with the new C-Leg 4 Update with over 10 new features including supported descent on ramps and stairs. The C-Leg 4 is easier and more intuitive than ever before.

An IP 67 rating provides protection from damage due to casual contact or temporary submersion in fresh water up to 1 meter for 30 minutes. The Genium provides the highest degree of intuitive function to individuals who need to adapt to changing environments, move quickly over short distances, or require more than 2 days of battery life. Genium

IP 67

An IP 67 rating provides protection from damage due to casual contact or temporary submersion in fresh water up to 1 meter for 30 minutes. X3

IP 68

The Genium X3 is the most durable, intuitive and technologically advanced microprocessor knee available. With features that support activities like running, swimming and ascending stairs step-overstep, X3 supports individuals who push the boundaries of mobility.

With an IP 68 rating, Genium also offers the highest level of water protection offered in a microprocessor knee.