The four member organizations of the Orthotic and Prosthetic Alliance-the National Association for the Advancement of Orthotics and Prosthetics (NAAOP); the American Board for Certification in Orthotics, Prosthetics & Pedorthics (ABC); the American Academy of Orthotists and Prosthetists (the Academy); and the American Orthotic & Prosthetic Association (AOPA)-along with the Board of Certification/Accreditation, International (BOC), announced their support for H.R. 1958, the Medicare Orthotic and Prosthetic Improvement Act of 2011.
The O&P Alliance and the BOC have issued a detailed rationale for their decision in an open letter. The letter explains the need for the legislation and outlines what it would accomplish.
“There is a long history that necessitates the introduction of this legislation,” the letter states. Specifically, the letter discusses the implementation of the Benefits Improvement and Protection Act of 2000, Section 427 (BIPA 427), which “recognizes more than one category of individuals who are considered ‘qualified’ to provide O&P services…” and Section 302 of the Medicare Modernization Act of 2003 (MMA), “which requires the establishment and implementation of quality standards for suppliers of durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS)” and the “accreditation of many DMEPOS suppliers.”
The letter states, “Unfortunately, when CMS [Centers for Medicare & Medicaid Services] implemented the DMEPOS Quality Standards and accreditation requirements, they did so without considering Section 427 of the BIPA law, which required accreditation of O&P suppliers by ABC, BOC, or other ‘equivalent’ accreditation organizations as deemed by the HHS [U.S. Department of Health and Human Services] Secretary. Under DMEPOS accreditation, CMS selected nine accreditation organizations to accredit DMEPOS suppliers, with no specific recognition of the BIPA law for O&P providers. The bottom line is that a flood of new accreditation organizations with little or no experience with the O&P profession were permitted to accredit O&P suppliers.”
H.R. 1958 was introduced in the 112th Congress on May 24, 2011, by Congresswoman Shelley Berkley (R-NV) and Congressman Glenn Thompson (R-PA). This bipartisan legislation is designed to reduce fraud and abuse in the Medicare O&P benefit while improving the quality of care and saving the government money. Specifically, the bill would accomplish the following objectives:
- Raise the standards for O&P accreditation organizations recognized by the Medicare program;
- Compel CMS to fully implement billing edits that would deny payment for unlicensed O&P suppliers submitting Medicare claims in those states that have O&P licensure; and,
- Link the right to bill Medicare for custom O&P care with satisfaction of appropriate education, training, and experience requirements.
The bill is expected to be introduced soon in the U.S. Senate.
Much of the legal framework for this bill is already in place at CMS, but this legislation would press CMS to fully implement regulations that would link the right of suppliers to bill the Medicare program with the complexity of O&P care provided and the qualifications of suppliers providing that care, the O&P Alliance said. As orthotic braces and prosthetic limbs are becoming more technologically advanced, there is a need for more advanced education, training, and experience of those who provide these services and devices to Medicare patients. Orthotics and prosthetics is very different from durable medical equipment (DME) in that O&P care is far more service oriented and clinically based, as well as being customized to the unique needs of every patient. H.R. 1958 recognizes these differences between O&P and DME and seeks to implement regulations that address potential fraud and abuse in the Medicare O&P benefit through O&P-specific solutions rather than DME-based approaches.
The O&P Alliance calls on all members of the O&P community to make their representatives in Congress aware of H.R. 1958 and urge them to cosponsor this important legislation.
