The National Association for the Advancement of Orthotics and Prosthetics (NAAOP) has released a webcast in which NAAOP General Counsel Peter Thomas, JD, discusses the U.S. Department of Veterans Affairs (VA) victory on private contracting, Medicare prior authorization, and off-the-shelf (OTS) orthotics. A summary of the video content follows:
VA Developments: Congress is poised to pass-and the President is expected to sign-major legislation impacting the Veterans Health Administration. NAAOP is proud to announce that one of the key provisions in H.R. 3408, the Injured and Amputee Veterans Bill of Rights, involving private contracting, is included in this bill.
Thomas said the private contracting provision in the soon-to-become-law, H.R. 3230, titled the Veterans Access to Care Act of 2014, is far broader than the provision in H.R. 3408 and applies to more than just O&P practitioners. But the concept is the same. The new law requires the VA to permit access to private practitioners when veterans cannot receive an appointment within 30 days or live more than 40 miles away from the nearest VA facility, in this case, the nearest VA O&P clinic. There are also specific provisions for those in highly rural areas. In order for a veteran to gain access to a private O&P practitioner, the practitioner must participate in the Medicare program, must agree to accept Medicare rates, and must retain all the licenses and credentials that Medicare requires.
How this new form of access for veterans interacts with the current system is not yet clear. Currently, over 80 percent of O&P care for veterans is provided by private practitioners under contract with the VA. Many of those contracts are at discounted rates off the Medicare fee schedule. The number of contracts totaled 600 in the past, more recently that number has been reduced as the VA strengthened its internal capacity to provide O&P care.
NAAOP said it will be working with its Alliance partners to clarify these new provisions and will alert its members as soon as more information is available. NAAOP will also continue to work to pass other aspects of the VA Bill of Rights in future VA legislation.
Prior Authorization: As for Medicare developments, Thomas said NAAOP submitted extensive comments in concert with the O&P Alliance on the prior authorization proposed rule. The Centers for Medicare & Medicaid Services (CMS) is proposing to extend prior authorization to certain O&P devices and related services. “While we have serious concerns about prior authorization and the delays in care that might flow from this new process, our comments focused on recommendations to improve the prior authorization process,” Thomas said. “For instance, NAAOP believes that once a prior authorization request has been approved by CMS, the agency and its contractors should be barred from reopening those claims and challenging the medical necessity of that O&P care. We appreciate all the comments submitted separately by NAAOP members. Only a strong show of force will get CMS to amend its proposed regulation when it publishes its final rule.”
Off-the-Shelf (OTS) Orthotics: A proposed rule was issued recently that seeks to further clarify the definition of “minimal self-adjustment” concerning the qualifications of suppliers providing custom-fitted services if those suppliers are not certified orthotists. In so doing, it seeks to further define who qualifies as an individual who has “specialized training” for the provision of custom-fitted orthotics. Thomas said that NAAOP is working with the O&P Alliance on comments and will distribute them widely before the September 2 deadline for submission of public comment.
The webcast is posted on the NAAOP website and on www.oandp.com, shared with members via e-mail, and made available through the NAAOP page on Facebook.
