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FEDERAL | ASPS Backs Coverage Bill for Congenital Defects

ASPS has been working with Senator Tammy Baldwin (D-WI) to introduce the Ensuring Lasting Smiles Act, which mandates necessary insurance coverage of reconstructive procedures for congenital defects from birth. In advance of the bill's formal introduction, ASPS has been active behind the scenes in an effort to secure a lead Republican cosponsor to join Sen. Baldwin as the bill's leading advocates. Bipartisan support of the measure is important to ensure the bill's success, which is why ASPS directly requested support from 10 members of the Senate GOP caucus. The Society also conducted a grassroots campaign in which it asked members in Colorado, Louisiana and Maine to sign petitions to Sens. Cory Gardner (R-CO), Bill Cassidy, MD (R-LA), and Susan Collins (R-ME), respectively, to become the lead Republican sponsor of this important measure. In the House of Representatives, Reps. Collin Peterson (D-MN) and David Young (R-IA) are slated to introduce the companion bill once a lead Republican sponsor has been secured in the Senate.

ASPS, along with the National Federation of Ectodermal Dysplasias (NFED) and the American Academy of Oral and Maxillofacial Surgeons (AAOMS), was an initial supporter during the drafting of this bill in January. The bill closely resembles the CARES Act, which ASPS advocated for in Washington, D.C. for numerous years, but which has not been reintroduced since the 112th Congress.

Baldwin's bill will require insurers to cover outpatient and inpatient diagnosis and treatment of congenital defects or birth abnormalities. Coverage must include any medically necessary care that serves to functionally repair or restore the body to achieve normal body function or appearance, as determined by a physician. The bill also specifies that coverage must include adjunctive dental, orthodontic or prosthodontic support from birth until the medical or surgical treatment of the defect or anomaly has been completed. Health plans must cover ongoing or subsequent treatment required to maintain function or approximate a normal appearance, procedures that do not materially affect the function of the body part being treated and procedures for secondary conditions and follow-up treatment.

Over 80 ASPS surgeons will advocate for this bill during the ASPS Advocacy Summit, which takes place this week in Washington, D.C.

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