NAAOP: Fighting for O&P

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By Michael J. Allen, CPO, FAAOP, President, NAAOP
Mike Allen, CPO, FAAOP, President, NAAOP
Mike Allen, CPO, FAAOP, President, NAAOP

The National Association for the Advancement of Orthotics and Prosthetics (NAAOP) is proud to be a part of the introductory issue of The O&P EDGE.

Since our inception over 15 years ago, we have been on the edge of legislative, administrative and regulatory issues affecting the O&P community. Currently, NAAOP is the only O&P trade association that advocates the standards approved by the Commission for Accreditation for Allied Health Education Programs (CAAHEP) for the providers of O&P care. We are committed to continuing that tradition with our fellow academicians and ABC-certified practitioners.

During the second session of the 107th Congress, NAAOP is actively engaged in many issues that will impact the ability of O&P practitioners to provide the level of appropriate care that the consumers of our services have come to expect and deserve.

Now, more than ever, is the time to consider joining NAAOP in advancing the O&P profession.

Michael Allen, CPO, may be contacted at Allen Orthotics & Prosthetics, 2502 West Ohio, Midland, Texas 79701; 915.683.3788; fax: 915.683.6470; e-mail:

"This is a very political year," noted NAAOP General Counsel Peter Thomas at the NAAOP legislative update briefing held during the Annual Meeting and Scientific Symposium of the American Academy of Orthotists and Prosthetists (AAOP). Prospects are slim for major health care legislation this year, he said. Senate Majority Leader Tom Daschle (D-SD) "doesn't want to pass any bill that will make President Bush look good."

The outlook for O&P appears cloudy, with some rays of sunshine peeking in.

The Medicare Payment Advisory Commission (MedPAC), an agency which reviews payment policies under the Medicare fee-for-service and managed care programs and makes recommendations to Congress, urges no fee cuts for physicians in the budget. Instead, MedPAC advises reducing fees from hospitals and other providers and adding these in to physician fees.

The Bush administration has consistently maintained that any changes in Medicare payments to providers need to be made on a budget-neutral basis, which means that, if funds are used to increase payments to one set of providers, then payments to others must be reduced. When the president released his budget to Congress in early February, it did not address many provider payment issues, including the Balanced Budget Act of 1997 provider payment revisions set to expire this year.

"O&P providers could gain or lose a great deal in the coming months, particularly with respect to the O&P fee schedule," Thomas said. "NAAOP is monitoring this situation closely."

Negotiated Rulemaking

The formation of the long-anticipated negotiated rulemaking committee to address the O&P provisions of BIPA will occur in 2002. CMS published the proposed rule in the Federal Register on March 22, 2002. NAAOP has been chosen to sit on the negotiated rulemaking committee, which will develop a proposed rule establish standards regarding the fitting, fabrication, and billing of Medicare for prosthetics and certain customized orthotics. NAAOP will strongly represent the interests of practitioners certified by the American Board for Certification in Orthotics and Prosthetics (ABC) and ABC-accredited facilities, Thomas said.

Competitive Bidding

The president's fiscal year 2003 budget proposal includes expanding competitive bidding for durable medical equipment (DME). Whether the Centers for Medicare and Medicaid Services (CMS) will include O&P as "DME" is not currently clear, "but indications to date suggest that it will," Thomas said. For the last ten years, NAAOP has consistently opposed competitive bidding, asserting that it lowers the quality of devices provided and lessens patient choice.

DMERC Region C Probe Audits

NAAOP contacted the Region C Durable Medical Equipment Regional Carrier (DMERC) regarding the DMERC's requesting "burdensome" additional documentation before paying claims. Thomas said that prosthetic audits seemed to have stopped, but not orthotic audits. "NAAOP should be notified immediately if an O&P practitioner experiences one of these pre-payment audits."

Coding Meetings

CMS apparently chose to exclude O&P from its public meetings relative to determining codings for new clinical laboratory tests and DME. CMS tends to be inconsistent when it does-and does not-include O&P with DME, Thomas noted. NAAOP submitted written comments to CMS urging the inclusion of O&P and is working with congressional supporters to encourage CMS to adopt this view.

Legislative changes in the TriCare program, which covers military personnel and their dependents, benefited O&P, Thomas said. Senator Ted Kennedy (D-MA) asked Thomas to help draft proposed legislation, which was passed without the usual changes and reductions. Although O&P was previously covered in TriCare, now replacements and repairs are also covered.

NAAOP Represents Providers, Users

One of the founding board members of NAAOP, Tom Guth, CP, of San Diego, California, pointed out that NAAOP represents not only practitioners, manufacturers, suppliers, and O&P facilities, but also consumers. Thus Congress, government agencies, and the general public can see that "we are not a self-seeking organization trying to pad its pockets." Guth stated, "It's better to fix laws while they are being made, rather than trying to change them after they pass." Guth was honored at the legislative briefing for his many years of dedication to NAAOP.

-Miki Fairley

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