HHS Releases Proposed State-Based Health Insurance Exchange Rules

The Department of Health and Human Services has released proposed rules that will govern the creation and administration of state-based health insurance exchanges. Created as part of the Affordable Care Act, state-based health exchanges are web portals created by state insurance agencies, that will allow consumers to shop and compare health insurance policies. Exchanges will also serve as the entry point to insurance subsides/tax credits for lower income consumers.  The roll out of the exchanges is scheduled to coincide with the implementation of the employer mandate in 2014.

The new rules proposed this week layout timelines for creation of the exchanges and the approval process with HHS.  HHS claims to provide as much flexibility as possible throughout the approval process, but if individual states do not act to setup their own health insurance exchange, the federal government will takeover the creation and implementation of the new program.  This poses a very difficult question to state governments that have resisted creating their own exchanges; either do it yourself, or the federal government will come do it for you.

The importance of the health exchanges as it relates to orthotics and prosthetics involves the “essential health benefits package”.  The essential benefits package (EBP) will serve as the minimum insurance plan that can be sold on the health exchanges, thereby requiring private insurance companies who wish to sell policies on the exchanges to cover atleast what is included in the EBP. HHS is currently awaiting a report from the Institute of Medicine before issuing their proposed minimum insurance plan later this year.  Studies have shown that some type of orthotics and prosthetics coverage exists in nearly 75% of group insurance plans and is also present in Medicare and Medicaid.

The inclusion of orthotics and prosthetics in the essential benefits package is a major priority of our profession.  If we gain entry into this package, it could possibly serve as a defacto “O&P parity” bill, requiring insurance companies to cover O&P services nationwide.

The O&P profession must fight for inclusion in the essential benefits package by asking our elected officials to contact the Department of Health and Human Services and voice their support for orthotics and prosthetics.

Contact OPGA Government Relations for help contacting your elected officials in Washington.  We can help write email messages, provide staff contacts and find local events in your area for you to attend during the August congressional recess.

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