The National Association for the Advancement of Orthotics and Prosthetics (NAAOP) released a webcast with a year-end update of policies that affect O&P. In the webcast, NAAOP General Counsel Peter Thomas, JD, discusses the following topics:
Spending Bill and the Affordable Care Act (ACA) Repeal: As Congress heads toward the holiday congressional recess, there is major unfinished legislative business to address, some of which has a direct impact on O&P providers and patients. An omnibus spending bill is being negotiated to fund the federal government past the December 12 deadline. If Congress is unable to agree to a spending bill by that date, they will have to pass another short-term resolution to continue funding federal government programs until a longer-term compromise can be achieved. This week, the Senate is working to pass a budget reconciliation bill that would repeal key aspects of the ACA. It is expected to pass the Senate with a simple majority vote but will be vetoed by the president.
Audits and Appeals: On the audit and appeals front, there is movement on the Senate Finance Committee’s efforts to streamline the Recovery Audit Contractors (RACs) and the Medicare appeals process. Legislative language has recently been shared that would directly impact O&P audits and appeals in a positive way. However, there is also a series of provisions in this draft bill applicable to all providers that would essentially erect barriers for providers to appeal claims denials. NAAOP is working in conjunction with the American Orthotic & Prosthetic Association (AOPA) and the O&P Alliance on this important legislation.
Inflation Update: The annual inflation update to the Medicare O&P fee schedule was released by Centers for Medicare & Medicaid Services (CMS) and, unfortunately, the lack of inflation created a negative update of 0.4 percent. This means that CMS will pay 0.4 percent less on the O&P fee schedule on January 1, 2016, than it is paying in 2015. This is based on a statutory formula created in 2010. In recent years, the formula created increases in inflation updates but this year resulted in a negative update. Short of changing the federal law, there is not much that can be done to oppose these reductions in reimbursement for O&P or for any provider under the Medicare program. In addition, sequestration will continue to siphon an additional 2 percent off of all Medicare provider fees.
Draft Local Coverage Determination (LCD) for Lower Limb Prostheses:The draft LCD continues to be available on the CMS and Durable Medicare Equipment Medicare Administrative Contractor (DME MAC) websites while CMS convenes the Lower Limb Prostheses Interagency Workgroup to study the issue of prosthetic coverage and try to arrive at a consensus statement on the issue. This workgroup must be limited to federal employees by law and is expected to meet throughout 2016. CMS has recently confirmed that it is investigating whether it can remove the Draft LCD from its website while deliberations on this policy area continue. The agency remains committed to including robust public stakeholder input into this policy as it takes shape next year, but how that actually occurs is still under development. A meeting between CMS and NAAOP/the O&P Alliance is being scheduled for January to discuss next steps.