The National Association for the Advancement of Orthotics & Prosthetics (NAAOP) announced that responding to pressure from individuals with amputations, prosthetists, and politicians, the executive director of New York’s health insurance exchange, Donna Frescatore, has ordered the elimination of a restriction limiting adults with amputations in New York to only one prosthesis per limb per lifetime. In a letter to Assembly member Kevin Cahill, chair of the New York State Assembly’s Insurance Committee, Frescatore confirmed that: “New York’s benchmark plan will be modified starting on January 1, 2016, to include coverage for the cost of repair and replacement of external prosthetic devices for both adults and children. The NY [New York] State of Health 2016 Health Plan Invitation will be amended to include this coverage requirement for the individual and small group marketplaces starting with benefit year 2016.”
New York prosthetist Dan Bastian, CPO, who has a transfemoral amputation, spearheaded bipartisan discussions on the topic with members of the New York State Assembly and Senate. He declared the result “a total victory for amputees in New York State.” Peter Thomas, JD, general counsel for NAAOP, which coordinated the New York effort agreed, noting that “not only does the order reverse a coverage limitation that clearly violates the Affordable Care Act, but equally important, the executive director acknowledged that a recent federal regulation requiring coverage for rehabilitative and habilitative devices includes prosthetic limb coverage. This sets an important precedent and provides amputees an important argument against restrictions in other states where prosthetics have been excluded from coverage entirely in plans offered through those insurance exchanges.”
The New York policy change marks the culmination of three months of intensive work and collaboration between NAAOP, New York prosthetists, patients, the Amputee Coalition, and other disability rights organizations to educate both the public and New York legislators about the one-limb-per-life restriction. An online petition drew more than 15,000 supporters and a legislative and agency-specific campaign resulted in victory. NAAOP President David McGill, JD, who strategized with the group and participated in meetings with New York legislators noted that “the New York victory proves that by combining the resources and intellectual capital of NAAOP with the efforts of highly engaged and motivated individuals like Dan Bastian and other local supporters, you can directly improve the lives of all amputees by providing them access to appropriate prosthetic care and treatment.”
“We were up against a June 1 deadline,” Bastian said. “After that, New York might not have been able to order changes to the benchmark until plan year 2017. So this is a great result for amputees in New York State-it could not have turned out any better.”