State By State

O&P State Policy Wins

Updates to Medicaid and other legislative changes from 2022

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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 AOPAnet.org/resources/co-op.

THIS YEAR SAW IMPRESSIVE GAINS in state-level O&P coverage and reimbursement. As 2022 comes to a close, it’s important to acknowledge the policy wins that have taken place across the country.

MEDICAID FEE SCHEDULE UPDATES

Arkansas

After discussions with providers in the state, Arkansas Medicaid has proposed a reimbursement rate increase to 90% of 2023 Medicare. For unlisted codes, reimbursement will be set at 80% of the 2023 Arkansas BlueCross BlueShield rate, or manually priced. Medicaid reimbursement rates were last set in 2006.

Illinois

Fifty-eight L codes were added to the Illinois Medicaid fee schedule in April, thanks to a proposal by the Illinois Society of Orthotists and Prosthetists. Reimbursement for these new codes, which include myoelectric and other high-tech components, is set at 2022 Medicare minus 6%.

Minnesota

As a result of advocacy efforts from a group of providers in the state, Minnesota Medicaid’s Lower-Limb Policy was updated in July to align K levels with Medicare, adjust coverage for several codes to include more K levels, and add a number of previously unlisted codes to the fee schedule. The group hopes to do the same with Minnesota Medicaid’s Upper-Limb Policy soon.

New York

In May, a coalition of O&P providers in the state successfully pushed for a New York Medicaid fee schedule increase to 80% of 2020 Medicare for 29 existing codes, as well as the addition of 35 codes that were previously missing from the fee schedule. These changes took effect June 1, and deliberations for the FY 2023 budget cycle are now underway.

ENACTED LEGISLATION

Iowa

In June, a bill allowing for multiple replacement prostheses for workers’ compensation patients over the course of their lifetimes, HF 2411, was signed into law. Previously, workers’ comp patients were only entitled to one replacement device. Under the new law, the portion of a settlement identified as the estimated lifetime cost of repair and replacement will be placed under control of the state treasurer in a separate fund to be dispensed as medically necessary.

Maine

Maine enacted LD 1003 in May, which mandates that state insurance plans cover, for enrollees under 18, an additional prosthesis intended for physical activity, including running, swimming, biking, or maximizing upper-limb function. AOPA’s newest state policy initiative aiming to increase children’s access to physical activity devices, So Kids Can Move, is based on the provisions outlined in LD 1003.

Virginia

HB 925 and SB 405, companion bills mandating prosthetic coverage in state insurance plans, took effect starting in July. Coverage includes myoelectric, biomechanical, and microprocessorcontrolled devices and repeals the existing requirement that coverage only be offered and made available.

For more information on these and other state developments, visit the AOPA Co-OP or contact Sam Miller at SMiller@AOPAnet.org.

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