The National Association for the Advancement of Orthotics and Prosthetics (NAAOP) has released a webcast in which NAAOP General Counsel Peter Thomas, JD, discusses four developments that have transpired since Election Day that are important to the O&P community.
- Court compels the U.S. Department of Health and Human Services (HHS) to extinguish the Administrative Law Judge (ALJ) backlog: The DC District Court compelled HHS to eliminate the extensive backlog of ALJ cases pending decision by 2020; ALJ review is the third of four levels in the administrative appeal process set out in the Medicare Act. Despite a 90-day statutory deadline for such decisions, ALJs are taking as long as 832 days due to the fact that over 750,000 denied Medicare claims await ALJ review. HHS must now figure out how to dispose of the cases within the court’s timeframe. This is a major victory for Medicare providers that NAAOP counsel, Powers, Pyles, Sutter & Verville, Washington DC, participated in. The decision will place great pressure on HHS to pursue settlement discussions.
- The Agency for Healthcare Research and Quality (AHRQ) seeks guidance on the evidence base for lower-limb prostheses: AHRQ released a questionnaire and seeks public comment on the evidence base for lower-limb prostheses. The questions are complex and require the attention of researchers, clinicians, and those in academia. NAAOP is working with the O&P Alliance, the Amputee Coalition, the National Commission on Orthotic and Prosthetic Education, and allied health organizations to provide a comprehensive response to this questionnaire by the December 20 deadline.
- O&P Medicare legislation makes gains and is poised for action in 2017: Despite extensive efforts led by the American Orthotic & Prosthetic Association and supported by NAAOP and the Alliance organizations, O&P legislative provisions advanced in Congress but were not included in the final legislation in the 114th Congress. No viable legislative vehicle emerged on which to append Medicare provisions. However, the O&P community is well positioned to advance these provisions in the new Congress. These provisions include recognition of the prosthetist’s clinical notes and separation of durable medical equipment from O&P.
- Congress passes a bill promoting rehabilitation research at the National Institutes of Health (NIH): As part of the 21st Century Cures Act, Congress passed legislation that NAAOP has considered a priority for the past several years. These provisions would elevate the stature and better coordinate rehabilitation and disability research at NIH. This bill will enhance NIH’s capacity and focus on O&P research. O&P research was the reason NAAOP was founded in 1987, an effort that culminated in legislation creating the National Center for Medical Rehabilitation Research (NCMRR). The mission of NCMRR is to conduct and support medical rehabilitation research “including orthotic and prosthetic research and development.”