This past week, a few different press releases and blogs commented that Arkansas just passed a bill through the statehouse that requires payors to reimburse for PRP and stem cell treatments? If true, this would be a game changer for physicians offering these services. However, like all things in life, this is a little bit of truth mixed with a whole lot of hyperbole. So don’t buy any plane tickets quite yet to Razorback country!
We have been monitoring this bill closely for a while. It started out as a bill that would have required payors in Arkansas to reimburse for regenerative-medicine treatments in orthopedics. However, the political process had its way with the bill, and what was passed was a shadow of its former self. So what does it say?
Right off the bat, you can already tell from the bill’s title and the word “explore” that this bill doesn’t force payors to do anything:
“AN ACT TO REQUIRE THE STATE AND PUBLIC SCHOOL LIFE AND HEALTH INSURANCE BOARD TO EXPLORE EMERGING THERAPIES AND COST-EFFECTIVENESS OF TREATMENT”
The actual bill language waters things down further:
(a) By the end of plan year 2017, the State and Public School Life and Health Insurance Board shall explore the evidence supporting opportunities for benefit modification informed by:
(1) The Choosing Wisely Initiative;
(2) Emerging therapies; and
(3) Therapeutic alternatives to invasive surgical procedures, such as regenerative injection therapy.
(b) By July of 2018, the State and Public School Life and Health
Insurance Board shall:
(1) Identify and consider implementation of pilot programs that include stepped therapy or center of excellence approaches, or both, for
which evidence demonstrates cost savings to the plan; and
Identify opportunities to stimulate conversations between patients and providers about appropriate and necessary treatment, including
treatment recommendations identified by the Choosing Wisely Initiative.
So what does all that mean? The idea was that the state health plan for government workers and the schools would be required to begin reimbursing for orthopedic regenerative-medicine procedures. However, once the bill was in committee, language was inserted to water it down.
What does it require the state to do? Well, it doesn’t require the state to do much other than to think about whether regenerative medicine might be a good idea to save money. Outside of that, nothing but a few meetings and the use of guidelines that may kill the project are required.
Note the highlighted words and phrases like “shall explore,” “consider,” “identify opportunities,” and “stimulate conversations.” This inserted language all but assures that the state health plan doesn’t have to do anything and is committed to nothing. It’s lots of legislative speak that sounds good but will ensure nothing gets accomplished.
The upshot? Should you move to Arkansas and begin billing the state health plan for PRP or stem cells? Nope. My guess is that the state health plan will kick your bills right back marked as “experimental” and unpaid. Is this Arkansas bill a start? Maybe. It opens the door for a conversation, but the language that passed is only a tiny crack in the door. So cancel those plane tickets to Arkansas other than to enjoy Razorback football and call them Hogs!
About the Author
Christopher J. Centeno, M.D. is an international expert and specialist in regenerative medicine and the clinical use of mesenchymal stem cells in orthopedics. He is board certified in physical medicine as well as rehabilitation and in pain management through The American Board of Physical Medicine and Rehabilitation.…