In July 2012, Pennsylvania lawmakers passed Act 90, which sets forth regulations and licensure requirements for O&P professionals. “The passage of this bill helps to ensure quality orthotic, prosthetic, and pedorthic care for citizens of the Commonwealth [of Pennsylvania],” Eileen Levis, president of the Pennsylvania Orthotic and Prosthetic Society (POPS), said at that time. “It validates the healthcare professionals providing that care and provides for a higher level of accountability.”
But Levis said Pennsylvania lawmakers went too far when they wrote Act 90, failing to let established, certified O&P practitioners keep practicing while they await state licensure, Adam Smeltz of Trib Total Media reported. Their deadline to obtain licensure is July 6. The Pennsylvania Board of Medicine issued about 150 licenses to specialists as of mid-June, though about 500 applied, Levis told Smeltz.
POPS is now one of ten other groups lobbying for House Bill 2242, which would amend Act 90 to allow certified specialists to continue working while the licensing requirement takes effect. The House approved the bill unanimously on June 20; it is now waiting deliberation by the Senate.
In the meantime, the Centers for Medicare and Medicaid Services (CMS) issued Transmittal 1385 on May 16, listing three additional states that require the use of a licensed or certified orthotist or prosthetist to furnish O&P devices, including Pennsylvania. The effective date is March 3, and the implementation date was June 17. This transmittal is based on Change Request (CR) 8390, which instructs the Durable Medical Equipment Medicare Administrative Contractors (DME MACs) to revise programming edits so that these additional states are added to the logic, in accordance with CR 3959 (originally issued on August 19, 2005). (CR 3959 instructed DME MACs to implement claims processing edits to ensure compliance with state regulations that require durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) suppliers who wish to bill Medicare to operate their business and furnish Medicare-covered items in compliance with all applicable federal and state licensure and regulatory requirements.)
Given the pending bill, CMS advised POPS that the National Supplier Clearinghouse Medicare Administrative contractor (NSC MAC) is aware of the issue in Pennsylvania and will not require licensure until confirmed by the state that the rules are finalized, Levis said. The new rules have not yet been introduced for public comment; there will be a 30-day comment period before the rules can be finalized.
“We will continue to keep practitioners in Pennsylvania informed as the process continues,” said Levis.
The American Board for Certification in Orthotics, Prosthetics and Pedorthics (ABC) takes a mixed view, Smeltz further reported. It supports allowing established, certified specialists to keep practicing while they pursue state licenses, but it questions a provision in the House bill that would grant a pedorthic or similar license when a worker dispenses over-the-counter devices for two years, he wrote.
“The intent of licensure, in our opinion, is to protect the public and to provide a means to assure that someone who’s providing healthcare has the proper qualifications,” Stephen Fletcher, the ABC clinical resources director, was quoted as saying.