HB 460 - FAIR CO-PAY LEGISLATION
HB 460 - FAIR CO-PAY LEGISLATION FOR PT + OT
Rep. Jeff LaRe (R-77) introduced HB 460, legislation that would create co-pay parity for physical and occupational therapy services. Currently, insurance carriers classify PTs and OTs as “specialists” and patients are often subjected to higher co-pays than they would be for seeing primary care providers. The goal of the bill is to remove the cost factor in choosing between physical and occupational therapy services or prescription opioids in treating pain management. Allowing therapy to be a more affordable option and removing this barrier to access is one means of addressing the opioid epidemic.
As defined in the bill, cost sharing is an out-of-pocket expense (i.e. copayment, coinsurance, deductible) made by an individual for services rendered by a physical or occupational therapist. Typically, the out-of-pocket expense for this type of therapy falls into the specialist category. The legislation will prohibit the cost sharing requirement for these services to not be greater than the cost sharing requirement for services provided by an individual’s primary care physician.
The OPTA and OOTA believe creating co-pay alignment with that of a primary care physician will allow more Ohioans to access the services of physical and occupational therapists.If passed Ohio would join other states such as Kentucky in enacting this policy.
Download the bill text As Introduced here.
Cosponsors:
REPRESENTATIVES
Jon Cross
Jay Edwards
Jennifer Gross
Joseph A. Miller III
Jean Schmidt
Status:
3/9/2022 - Proponent Testimoney - OPTA President Dr. Tonya Apke (link here--25 min mark)
2/16/2022 - Sponsor Testimony - Rep. LaRe (Link here)
10/26/2021 - Referred to House Insurance Committee
10/19/2021 - Introduced
Take Action Now!
Contact your state representatives using our widget and urge their support for HB 460! Use the pre-populated emails and texts and make an impact!
Talking Points:
- Currently, insurance carriers classify PTs and OTs as “specialists”. This means patients are subjected to higher co-pays than they would be for seeing primary care providers.
- The goal of the bill is to remove the cost factor in choosing between physical and occupational therapy services or prescription opioids in treating pain management.
- Allowing therapy to be a more affordable option and removing this barrier to access is one means of addressing the opioid epidemic.
- Every year millions of Americans use opioids to manage pain. Doctor-prescribed opioids are appropriate in some cases, but they just mask the pain—and reliance on opioids has led to the worst drug crisis in American history.
- Removing barriers to access and limiting the co-pay for individuals to that of a primary care physician will encourage non-pharmacologic approaches to pain management.
- Affordable co-pays will encourage the long-term treatment of pain through movement—not the masking of pain through opioid usage.
- The Centers for Disease Control and Prevention (CDC) recommends safe alternatives like physical therapy for the management of most non–cancer-related pain.
- Physical therapists (PTs) and physical therapist assistants (PTAs) have a responsibility to understand the full scope of the epidemic and its potential impact on their patients and clients.
- Physical therapy is effective for numerous conditions, and the CDC cited “high quality evidence” supporting exercise as part of physical therapist treatment for familiar conditions like low back pain, hip and knee osteoarthritis, and fibromyalgia. Opioid effectiveness for long-term pain management is inconclusive in many cases.
- Alternative to surgery: Physical therapy has been found to be as effective as surgery for conditions including meniscal tears and knee osteoarthritis, and rotator cuff tears—thus, saving the healthcare system the cost of unnecessary surgeries.
HB 460 - FAIR CO-PAY LEGISLATION
HB 460 - FAIR CO-PAY LEGISLATION FOR PT + OT
Rep. Jeff LaRe (R-77) introduced HB 460, legislation that would create co-pay parity for physical and occupational therapy services. Currently, insurance carriers classify PTs and OTs as “specialists” and patients are often subjected to higher co-pays than they would be for seeing primary care providers. The goal of the bill is to remove the cost factor in choosing between physical and occupational therapy services or prescription opioids in treating pain management. Allowing therapy to be a more affordable option and removing this barrier to access is one means of addressing the opioid epidemic.
As defined in the bill, cost sharing is an out-of-pocket expense (i.e. copayment, coinsurance, deductible) made by an individual for services rendered by a physical or occupational therapist. Typically, the out-of-pocket expense for this type of therapy falls into the specialist category. The legislation will prohibit the cost sharing requirement for these services to not be greater than the cost sharing requirement for services provided by an individual’s primary care physician.
The OPTA and OOTA believe creating co-pay alignment with that of a primary care physician will allow more Ohioans to access the services of physical and occupational therapists.If passed Ohio would join other states such as Kentucky in enacting this policy.
Download the bill text As Introduced here.
Cosponsors:
REPRESENTATIVES
Jon Cross
Jay Edwards
Jennifer Gross
Joseph A. Miller III
Jean Schmidt
Status:
3/9/2022 - Proponent Testimoney - OPTA President Dr. Tonya Apke (link here--25 min mark)
2/16/2022 - Sponsor Testimony - Rep. LaRe (Link here)
10/26/2021 - Referred to House Insurance Committee
10/19/2021 - Introduced
Take Action Now!
Contact your state representatives using our widget and urge their support for HB 460! Use the pre-populated emails and texts and make an impact!
Talking Points:
- Currently, insurance carriers classify PTs and OTs as “specialists”. This means patients are subjected to higher co-pays than they would be for seeing primary care providers.
- The goal of the bill is to remove the cost factor in choosing between physical and occupational therapy services or prescription opioids in treating pain management.
- Allowing therapy to be a more affordable option and removing this barrier to access is one means of addressing the opioid epidemic.
- Every year millions of Americans use opioids to manage pain. Doctor-prescribed opioids are appropriate in some cases, but they just mask the pain—and reliance on opioids has led to the worst drug crisis in American history.
- Removing barriers to access and limiting the co-pay for individuals to that of a primary care physician will encourage non-pharmacologic approaches to pain management.
- Affordable co-pays will encourage the long-term treatment of pain through movement—not the masking of pain through opioid usage.
- The Centers for Disease Control and Prevention (CDC) recommends safe alternatives like physical therapy for the management of most non–cancer-related pain.
- Physical therapists (PTs) and physical therapist assistants (PTAs) have a responsibility to understand the full scope of the epidemic and its potential impact on their patients and clients.
- Physical therapy is effective for numerous conditions, and the CDC cited “high quality evidence” supporting exercise as part of physical therapist treatment for familiar conditions like low back pain, hip and knee osteoarthritis, and fibromyalgia. Opioid effectiveness for long-term pain management is inconclusive in many cases.
- Alternative to surgery: Physical therapy has been found to be as effective as surgery for conditions including meniscal tears and knee osteoarthritis, and rotator cuff tears—thus, saving the healthcare system the cost of unnecessary surgeries.