The Centers for Medicare & Medicaid Services (CMS) submitted a proposed rule on July 2 that, among other things, clarifies the definition of the term “minimal self-adjustment” as it relates to the provision of custom-fitted and off-the-shelf (OTS) orthoses and seeks to adjust the Durable Medical Equipment Prosthetics, Orthotics, and Supplies (DMEPOS) Fee Schedule. The formal proposed rule is scheduled to be published in the Federal Register on July 11. Comments will be accepted through September 1. Summaries of the proposed rule that pertain to O&P follow:
Proposal to update the definition of minimal self-adjustment.
The proposed rule seeks to update the definition of minimal self-adjustment to make clear that minimal self-adjustment means an adjustment that the beneficiary, caretaker for the beneficiary, or supplier of the device can perform and does not require the services of an American Board for Certification in Orthotics, Prosthetics and Pedorthics (ABC)- or Board of Certification/Accreditation (BOC)-certified orthotist, a physician, or a treating practitioner (a physician assistant, nurse practitioner, or clinical nurse specialist), an occupational therapist, or a physical therapist.
Proposal to adjust the DMEPOS fee schedule.
This rule proposes to use pricing information from the Medicare DMEPOS Competitive Bidding Program (CBP) to make national price adjustments to the DMEPOS Fee Schedule for items provided in non-competitive bidding areas, beginning January 1, 2016. The rule proposes to use the same methodologies to adjust the fee schedule amounts for enteral nutrition and off-the shelf
(OTS) orthotics in areas where CBPs are not implemented.
For more information, including how to submit comments, read the proposed rule, Medicare Program; End-Stage Renal Disease Prospective Payment System, Quality Incentive Program, and Durable Medical Equipment, Prosthetics, Orthotics, and Supplies, in the Federal Register.