The Ostomy Files: United Ostomy Association Issues Advocacy Report Card
In mid-February, the United Ostomy Association (UOA) Government Affairs Committee published its Advocacy Report Card 2003.
The Committee, chaired by Linda Aukett, has been extremely proactive in voicing the concerns of the UOA's membership and other parties with a vested interest in the ostomy community (healthcare professionals, manufacturers, distributors, and similar patient support organizations). Through direct and indirect communication with the public policy establishment (eg, Congress, the Centers for Medicare and Medicaid Services [CMS], and the Government Accounting Office), the Committee has been able to participate in and effect policy decisions that directly impact a person living the ostomy experience. Last year, UOA's advocates sent a total of 1,029 messages to Congress and others on topics of interest to the UOA and its members. Their Report Card 2003 summarizes the Committee's activities in 2003.
In striving to make it easier for suppliers to accept Medicare assignment for ostomy supplies and to reduce the overall out-of-pocket expenses for their membership, the Committee was deeply involved in attempting to increase Medicare fee schedule amounts for certain ostomy supplies. The UOA was successful in gaining increases in selected product categories (eg, two-piece drainable pouches) that were previously reimbursed so poorly that patient right to use was affected because retailers would not accept assignment on them. Several new HCPCS codes and fees were introduced in April 2003, with fee increases outnumbering decreases three-to-one and ranging between 5% to 153%, with an average increase of 35%. Decreases in allowables ranged between 4% and 7%. The following two-piece pouch categories were not updated until 2004, but continue to reflect increases.
: A5063 - two-piece drainable pouch $2.70 each
: A4426 - two-piece drainable pouch w/locking flange $2.73 each
: A4427 - two-piece drainable pouch w/locking flange and filter $2.78 each
: A4423 - two-piece closed pouch w/locking flange and filter $1.85 each
What's in the Future
The Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA) establishes a competitive bidding program that is slated to begin, at the earliest, in 2009. As it is currently structured, the program provides for regional contracting and fee schedules. The Secretary of Health and Human Services has the authority to exclude product categories that would not result in significant savings to CMS. The UOA will be lobbying hard to ensure that ostomy products fall into that exclusionary category.
Due to cuts in state-funded programs and tight state budgets, many states have either cut their Medicaid benefits or tightened eligibility requirements. The Committee tracked ostomy supply coverage in several states where the benefits for coverage of ostomy supplies were threatened - California, Oregon, and New York. Due to the response from UOA membership, ostomy supplies are still available through California's Medicaid program, Medi-Cal. The Committee understands the ongoing risk in other states and remains vigilant regarding similar issues in other state Medicaid programs, particularly Massachusetts.
Ostomy Coverage for Non-Medicare Individuals
United Healthcare denied coverage of ostomy supplies in their "fully-insured" health plan options to employers. Due in part to pressure from the UOA, United Healthcare has agreed to help people enrolled in their "fully-insured" plans to obtain the ostomy and other medically necessary medical supplies they require. However, people who need this coverage may be required to purchase a special rider or obtain discounted supplies through a single provider via a special program operated by United Healthcare.
Connecticut is the only state with a mandate for coverage of ostomy supplies for people who have private insurance. The UOA has been instrumental in having comparable bills introduced in Massachusetts and Florida. An Arizona legislator also has promised to introduce a similar bill.
The UOA has entered into agreement with Netscan iPublishing's LegAlert service. This service scans legislative activity at the state and federal level and contacts the Committee when it discovers legislation of interest to the UOA, allowing the Committee to be proactive rather than reactive.
In an effort to mobilize members, the UOA encourages participation in the Advocacy E-list at http://capwiz.com/uoa/home/. This permits open communication between members and the Committee and an opportunity for members to voice their opinion on an issue. United Ostomy Association chapters also are able to use the Capwiz Media Guide to communicate with local papers about their upcoming meetings and programs (http://capwiz.com/uoa/dbq/media/).
Last year, UOA members participated in a variety of events, including two in Washington, DC (The National Institutes of Health and The Centers for Disease Control and Prevention) aimed at increasing funds for these government agencies because they conduct research on diseases relevant to ostomy and activities to promote colon cancer screening. Additional participation by the UOA was evident at the Public Policy Forum of the Digestive Disease National Coalition and One Voice Against Cancer. Team visits were made to congressional offices to educate legislators about the value of this research and to urge their support for additional funding.
The UOA Government Affairs Committee has expanded its scope to include all vested parties involved in improving the life of a person with a stoma - from advocating for coverage of ostomy supplies to lobbying for additional funding for research to easing the financial burden on their members' out-of-pocket expenses for their supplies. This Committee has set a benchmark for other advocacy groups. Each of these efforts is crucial to improving the quality of life of Americans living the ostomy experience.