The National Association for the Advancement of Orthotics and Prosthetics (NAAOP) released a webcast during which NAAOP General Counsel Peter Thomas, JD, provides an update on S. 829, the Medicare Orthotics and Prosthetics Improvement Act of 2015, and discusses proposed regulations on Medicare Appeals. A summary follows:
S. 829 Follow-up: The Medicare Orthotics and Prosthetics Improvement Act (S. 829) continues to gain cosponsors in the Senate, thanks to the efforts of O&P practitioners and patients across the nation who have been contacting their senators and asking them for support. NAAOP members have done their part in reaching out to key Senate offices seeking additional support for this important legislation. The bill would recognize the clinical notes of the O&P practitioner as part of the patient’s medical record, separate durable medical equipment (DME) from O&P, and accomplish a number of other O&P policy improvements. If you have not yet contacted your senators, NAAOP asks you to do so now. Visit www.naaop.org and click on the Legislative Action Center. The July webcast provides detailed instructions to assist in accomplishing this important task.
NAAOP is also asking you to go the extra mile and invite your members of Congress and senators to visit your clinic during this political season. All members of Congress and one-third of the Senate are up for reelection in this election cycle and all of them are actively looking for ways to meet constituents, align themselves with attractive human interest stories, appeal to voters, and gain unpaid media attention. There is no better way to do this than to visit an O&P clinic, tour the facility, and meet patients whose lives have been touched by O&P care. There is no better time to help develop O&P champions through this one-on-one advocacy.
Proposed Regulations Issued for Medicare Administrative Law Judge (ALJ) Appeals: In early July, the Office of Medicare Hearings and Appeals (OMHA) issued proposed regulations that will make significant changes to the Medicare administrative appeals process. Most of these changes are detrimental to providers but some are more positive. The regulations were presumably issued to try to address the deepening appeals crisis. There are over 750,000 appeals pending at OMHA and the agency has capacity to resolve only 77,000 cases each year. This means a ten-year backlog of cases, and the denials and related appeals keep entering the system faster than they can be resolved. The average time for an ALJ appeal to be decided is reported by OMHA as 832 days, despite the statutory requirement that such decisions occur within 90 days. In short, the situation is unsustainable.
NAAOP is working with the O&P Alliance to file comments on these proposed regulations by the August 29 deadline. NAAOP is opposed to the proposal to make the 90-day deadline for ALJ decisions permissive rather than mandatory, as the statute requires. NAAOP also opposes granting authority to the Medicare Appeals Council to pick and choose which cases will have precedential value, meaning if one case is denied by the Council, similar cases in the appeals backlog may also be denied. Finally, NAAOP supports other provisions in the proposed rule that would make it easier for providers to get a fair hearing and not be overwhelmed by Medicare contractors in the course of the ALJ hearing itself. In short, NAAOP will seek to protect the interests of O&P providers and the patients they serve in the context of this proposed regulation.