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Please send this letter to your representative urging them to support H.R. 2479,
the Medicare Orthotic and Prosthetic Improvements Act which is designed to fight Medicare fraud and abuse by criminals and unqualified persons seeking to take advantage of those who need orthotic and prosthetic care
& H. R. 2575,
the federal orthotic and prosthetic parity legislation assures fairness by private insurers paralleling efforts already concluded in 15 states.
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I am writing to urge you to assure that the health care reform legislation making its way through Congress does not leave out amputees and patients with limb impairment. There are two critical bills which need to be incorporated into this massive legislation regarding the treatment of prostheses (artificial limbs) and orthoses (braces) by Medicare and private insurers. Legislation is greatly needed in order to treat persons with limb loss and impairment to ensure that appropriate, functional, cost effective orthotic and prosthetic care is available for Medicare beneficiaries and the need for federal orthotic and prosthetic parity legislation. H.R. 2479, the Medicare Orthotic and Prosthetic Improvements Act is designed to fight Medicare fraud and abuse by criminals and unqualified persons seeking to take advantage of those who need orthotic and prosthetic care, like that highlighted in a recent 60 Minutes feature. H.R. 2479 will ensure that the Centers for Medicare and Medicaid Services (CMS) only pays for quality care that is provided by appropriately credentialed practitioners, operating in appropriately accredited facilities. It will also direct CMS to enforce Medicare Transmittal 656, issued in 2005, which limits Medicare reimbursement for orthotic and prosthetic devices to only those suppliers who are licensed under state law to provide these specific products (in states where licensure is available). In states that do not require licensure, Medicare payment is made only to those providers who meet selected certification and accreditation standards. And finally, it will link payment for orthotic and prosthetic care to the complexity of the device and the qualifications of the practitioner. H.R. 2479 also offers some solid savings—estimated in a CBO-type analysis to be at least $100 million, and possibly up to $200 million per year (between $1-2 billion over ten years). H.R. 2575, the federal orthotic and prosthetic parity legislation assures fairness by private insurers paralleling efforts already concluded in 15 states. Many private insurers do not provide comprehensive prosthetic and orthotic coverage such as that provided by the federal Medicare plan. Some of those who say they provide coverage encumber coverage for these devices or limit coverage with unrealistic caps. For amputees and those needing orthoses, the lack of coverage or limitations on coverage often prevents them from leading full and productive lives. In addition, not having access to appropriate devices can lead to costly co-morbidities due to the imposed sedentary lifestyle. These conditions can include orthopedic problems, obesity, diabetes, and peripheral vascular disease. H.R. 2575 would remedy this—it is NOT a mandate, but simply assures that insurers who choose to offer orthotics and prosthetics coverage must offer this benefit on the same terms as other general medical or surgical coverage, without caps or other limits applying only to prosthetic limbs and orthotic devices. This bill is endorsed by the Amputee Coalition of American, the United Cerebral Palsy and the March of Dimes and many other organizations that represent persons with disabilities. There are no government costs, and enactment of H.R. 2575 would actually reduce state Medicaid and vocational rehab expenditures. Independent estimates report projected costs of assuring such fundamental fairness to these patients at about 5 cents per beneficiary per month, or about 60 cents per beneficiary per year. We are asking your support for inclusion of these two bills in health care reform legislation. Such legislation would be deeply flawed if it did not provide for America’s amputees and persons with limb impairment. Thank you for your time and attention to this matter.. For more information, please feel free to contact me or Thomas F. Fise, Executive Director of the American Orthotic & Prosthetic Association at 571/431-0814 (tfise@AOPAnet.org).
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