The National Association for the Advancement of Orthotics and Prosthetics (NAAOP) has released its latest webcast in which general counsel Peter Thomas, JD, comments on the latest from the U.S. Department of Veterans Affairs (VA), which is still deciding who will provide O&P care for eligible veterans.
The Prosthetic and Sensory Aids Service (PSAS) briefed the Federal Advisory Committee on Prosthetics and Special Disabilities on October 17 about the status of the proposed rule that would grant the VA the sole authority to determine whether a VA orthotist/prosthetist or a private, VA-contracted orthotist/prosthetist will furnish O&P care to an eligible veteran.
Thomas said the VA received over 300 public comments about the proposed rule, including from NAAOP and the O&P Alliance, but the proposal has largely remained dormant since the comment period closed in December 2017. It is unclear whether the VA intends to finalize the proposed rule in its current form, modify its proposals, or rescind the rule, Thomas said. The PSAS suggested that the VA could take up to a year, or possibly longer, Thomas said, to finalize the rule.
A potential reason for this extended timeframe is that the VA is in the process of announcing regulations under the recently enacted VA Maintaining Systems and Strengthening Integrated Outside Networks (MISSION) Act, which allows veterans to gain access to non-VA, community providers for primary care and related services, Thomas said. Once the proposed rule on O&P provision is finalized, the PSAS has indicated it would update existing handbooks and policies to ensure consistency.
NAAOP will continue to monitor the status of the proposed rule and advocate against eliminating veterans’ long-standing right to select the orthotist and prosthetist who best serves their specific needs, whether the orthotist or prosthetist is a VA employee or has a VA contract, Thomas said.
In addition to the discussion on the proposed rule, the PSAS clarified that the threshold reimbursement amount for prosthetics under the VA is being raised from $3,500 to $10,000 per claim. Essentially, prosthetic devices with reimbursement levels up to $10,000 may be purchased directly by VA prosthetics staff from non-VA providers, without going through the formal VA procurement process, Thomas said. This will likely have a positive impact on orthoses purchased by the VA from private orthotists with VA contracts and have less of an impact on prostheses as these typically cost more than $10,000, he said.
Finally, the PSAS confirmed that “urgent” or “emergent” prosthetic items (splints, crutches, slings, or soft collars) are being covered under the MISSION Act’s Patient Centered Community Care contracts, while non-urgent and non-emergent items (the majority of custom orthotics and prosthetics) will continue to be provided by PSAS under the existing reimbursement system, Thomas said.