STATE BY STATE
Regional News Updates from Illinois, Kansas, Michigan, New York, Texas, and Washington
Illinois
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.
NEW MEMBER RESOURCE ALERT
AOPA has invested in a new resource that allows us to track legislative and regulatory activity related to O&P in every state. We will be updating the state pages on the AOPA Co-OP with alerts as they arise.
Following the Jan. 1, 2021, rollout of the Medicare Competitive Bidding Program for off-the-shelf orthoses, Illinois HB 62 proposes the creation of the Pharmaceutical and Durable Medical Goods Committee to negotiate the prices of pharmaceuticals and durable medical goods with suppliers or manufacturers on an open-bid competitive basis for the state. The Illinois Society of Orthotists and Prosthetists opposes this legislation and seeks to exclude custom orthotic, prosthetic, and pedorthic (OPP) care based on definitions in the Illinois OPP Practice Act and the qualified OPP provider language.
Kansas
The updated BCBS Kansas policy titled “MicroprocessorControlled Prostheses for the Lower Limb” has been flagged by AOPA and members in Kansas. AOPA is currently reviewing the policy and discussing a possible medical review request with the insurer. Please visit the AOPA Co-OP for updates.
Michigan
Submit Your State News To submit an update for publication in the State by State department of O&P Almanac, email awhite@AOPAnet.org.
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Members in Michigan and the Michigan Orthotic and Prosthetic Association have reported that they are in the beginning stages of seeking legislation that would limit the amount that any payor could undercut Medicare/ Medicaid rates for prosthetic coverage.
Become an AOPA State Rep.
If you are interested in participating in the AOPA State Reps network, email awhite@AOPAnet.org.
New York
Working closely with members and on behalf of the New York AAOP Chapter, AOPA has conducted two successful letter-writing campaigns designed to garner support for a Medicaid fee schedule raise, resulting in more than 300 letters written to New York state representatives. For details, visit the New York page of the AOPA Co-OP.
Texas
In Texas, HB 2134—Relating to Coverage for Childhood Cranial Remolding Orthosis Under Certain Health Benefit Plans—has been referred to the Insurance Committee and scheduled for a public hearing, the date of which is to be determined. AOPA will continue to share updates on HB 2134 via the AOPA Co-OP.
Washington
A bipartisan coverage bill has been introduced in Washington, co-sponsored by eight Republicans and nine Democrats. HB 1427 specifies that health plans issued or renewed on or after Jan. 1, 2022, must provide coverage for benefits for prosthetics and orthotics that are at least equivalent to the coverage provided by the federal Medicare program, and no less favorable than the terms and conditions for the medical and surgical benefits in the policy.
