NAAOP Webcast: Support the Medicare O&P Improvement Act
January 09, 2018
The National Association for the Advancement of Orthotics and Prosthetics (NAAOP) has released a webcast in which General Counsel Peter Thomas, JD, requests comments be submitted in support of the Medicare O&P Improvement Act of 2017. A summary of the webcast follows:
The House and Senate are considering inclusion of key provisions of the Medicare O&P Improvement Act (S. 1191 and H.R. 2599) in the Medicare extenders legislation expected to be considered in the coming weeks. The Medicare O&P Improvement Act is bipartisan legislation introduced by Senators Chuck Grassley (R-IA) and Mark Warner (D-VA) and Congressmen Glenn Thompson (R-PA) and Mike Thompson (D-CA). It is designed to improve the quality of patient care and treatment outcomes while limiting waste, fraud, and abuse in the Medicare orthotic and prosthetic benefit.
There are critical provisions in the act that should be included in the Medicare extenders legislation and passed immediately, NAAOP says.
Recognition of Clinical Notes: The House has already passed one of the provisions in the bill (Section 5) as part of the Medicare Part B Improvement Act (H.R. 3178, Section 103). This provision would clarify that the clinical notes of the prosthetist or orthotist are considered part of the patient's medical record, and will help establish the medical necessity of prostheses and orthoses provided to Medicare beneficiaries.
Linking O&P Provider Qualifications with Medicare Billing Privileges: Section 8 of the Medicare O&P Improvement Act directs the Centers for Medicare & Medicaid Services (CMS) to issue regulations on BIPA Section 427, a section of the federal law that was enacted in 2000 but never implemented. Congress should enact this provision to require CMS to implement this federal law governing the qualifications necessary to provide custom-fabricated orthotics and prosthetics to Medicare beneficiaries, NAAOP says.
Clarifying the Scope of Off-the-Shelf Orthotics: Congress exempted custom O&P care from Durable Medical Equipment (DME) competitive bidding in the Medicare Modernization Act of 2003, but permitted competitive bidding for off-the-shelf orthotics, defined in the statute as orthoses requiring "minimal self-adjustment." CMS subsequently issued regulations that dramatically expanded the scope of off-the-shelf orthotics, contrary to congressional intent. Section 7 of the Medicare O&P Improvement Act would restore the original definition, protecting patients who require orthotic treatment by ensuring they receive the clinical services needed for orthoses to fit and function properly.