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CMS Formally Defines Orthotics and Expands Coverage of Power Orthoses

by Peter Thomas, JD
January 4, 2024
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The Centers for Medicare & Medicaid Services (CMS) released the calendar year 2024 Home Health Prospective Payment final rule (Final Rule) on November 3, which contains a section finalizing the definition of an orthotic “brace” in federal regulations and expanding coverage of powered orthoses. CMS states in the rule that patients will have expedited access to powered orthoses, a recognition that the Medicare agency is focusing on facilitating access to new technology, which differs from CMS’ traditional reluctance to embrace coverage of new assistive devices and technologies. This constitutes a major win for the O&P community as well as the broader rehabilitation and disability communities.

The five O&P Alliance organizations (the National Association for the Advancement of Orthotics and Prosthetics, American Orthotic & Prosthetic Association, American Academy of Orthotists and Prosthetists, American Board for Certification in Orthotics, Prosthetics & Pedorthics, and the Board of Certification/Accreditation) strongly supported the proposed rule issued in June. They were joined by numerous rehabilitation and disability organizations coordinated through the Independence Through Enhancement of Medicare and Medicaid Coalition. Organizations such as the Amputee Coalition, American Academy of Physical Medicine and Rehabilitation, Christopher and Dana Reeve Foundation, Paralyzed Veterans of America, Spina Bifida Association, United Cerebral Palsy, and United Spinal Association supported the proposed rule and celebrated the final rule’s publication.

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