This post was written by APMA’s Director of Scientific Affairs James R. Christina, DPM.

James R. Christina, DPM

On Tuesday October 18, I had the opportunity to provide testimony for APMA at the Department of Health and Human Services (DHHS) on the Essential Health Benefits (EHB) package.  Testifying was an important opportunity to make sure services of podiatrists were considered part of the EHB package and I believe the experience resulted in some positive outcomes for podiatrists.

When Congress enacted the Affordable Care Act, it mandated that a broad package of “essential health benefits” equivalent to that of a “typical employer plan” be offered by qualified health plans participating in state-based insurance exchanges, as well as by new plans offered to individuals and small employers outside these exchanges. Congress directed the DHHS to flesh out the details.  APMA has been actively communicating with DHHS over the past several months, which resulted in the opportunity to provide comments at this hearing.

These were the questions that the DHHS asked that testimony address:

• How can the DHHS best meet dual goals of balancing the comprehensiveness of coverage included in essential health benefits and affordability?
• How might the DHHS ensure that essential health benefits reflect an appropriate balance among the categories so that they are not unduly weighted toward any category?
• What policy principles and criteria should be taken into account to prevent discrimination against individuals because of their age, disability status, or expected length of life as the Affordable Care Act requires?
• What models should the DHHS consider in developing essential health benefits?
• What criteria should be used to update essential health benefits over time and what should the process be for their modification?

In any testimony situation, there is always some tension with regards to what will occur.  I did not know how much time I would have or what the exact format was for the hearing.  As it turned out, there was no time limit, but they broke the discussion up based on the above questions.  I adapted my testimony to focus on including coverage for preventive foot care for high risk patients and on the value that podiatry provides in caring for people with chronic disease such as diabetes.

My overall impression was that foot and ankle care would be covered under ambulatory patient services and there was no indication that there would be any attempt to limit which providers were responsible for foot and ankle care.  However, as the DHHS attempts to balance coverage and costs, there will be a greater emphasis on evidence-based medicine and justifying the medical necessity of the care provided.