Peter Thomas, JD, general counsel of the National Association for the Advancement of Orthotics and Prosthetics (NAAOP), spoke about the new rules to help O&P providers challenge Medicare Advantage (MA) denials. He also welcomed the 2023 NAAOP Breece Fellow, Kate Ketelhohn, who began her fellowship program in Washington DC this month to learn more about O&P policy and advocacy.
Regarding new MA rules, on April 12, the Centers for Medicare & Medicaid Services published the contract year 2024 Policy and Technical Changes to the Medicare Advantage and Medicare Prescription Drug Benefit Programs Final Rule revising provisions of the MA program. The final rule includes substantial changes to MA, Thomas said, including instituting guardrails around the use of prior authorization. The final rule became effective on June 5, although the policies will be implemented in the new contract year starting on January 1, 2024.
NAAOP and several other O&P organizations strongly supported the proposed rule in written comments submitted earlier this year, Thomas said. For the first time, the final rule implements several policies that will make it easier for O&P practitioners to challenge denials of MA claims for O&P care. For example, Thomas said, the new rules require MA plans to abide by fee-for-service or “traditional” Medicare coverage rules, limit the use of internal MA or third-party proprietary coverage guidelines, guarantee a 90-day prior authorization transition period for a beneficiary switching plans, and limit prior authorization as a utilization management tool. They also require that reviewers of MA claims possess training and experience in the medical field in which the claim is being considered.
Thomas also welcomed Ketelhohn, who is already working on several projects, including researching new Veterans Administration policies, and a white paper on osseointegration. In addition, she will help orchestrate an NAAOP Virtual Fly-In in July to help build support for the Medicare O&P Patient-Centered Care Act. She will also help organize and present a webinar at 1 p.m. July 27 about the new rules to help O&P practitioners challenge MA denials of claims.
To watch the latest NAAOP update, visit its YouTube page
