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 emerging consensus within the O&P community on the definitions of qualified practitioners and qualified suppliers. A summary of the webcast follows:
After lengthy discussions among the NAAOP board of directors, O&P Alliance organizations, and other stakeholder groups, consensus on the proposed rule that interprets the Benefits Improvement and Protection Act of 2000 (BIPA) Section 427 is beginning to emerge. BIPA Section 427 states that “no payment will be made” by the Medicare program for prosthetics and custom-fabricated orthotics unless they are provided by “qualified practitioners” and “qualified suppliers.” On January 12, the Centers for Medicare & Medicaid Services (CMS) issued proposed regulations on this provision to implement this long-overdue requirement.
CMS surprised many by interpreting the statute broadly, applying new training, education, and certification requirements on all “professionals” who submit Medicare claims for custom fabricating O&P devices, including physicians, physical therapists, and occupational therapists. The proposed rule also requires accreditation of all qualified suppliers by the American Board for Certification in Orthotics, Prosthetics and Pedorthics (ABC), the Board of Certification/Accreditation (BOC), or an “equal” accrediting organization designated as such by CMS. Off-the-shelf orthotics are not impacted by the proposed rule.
NAAOP’s board and its members have been grappling with its comments to the proposed rule because of the broad scope of the rule. On the one hand, the proposed rule could be viewed as a major victory for the O&P profession in that CMS has recognized the importance of specific training, education, and credentialing for healthcare professionals and suppliers to provide complex and customized O&P care. This interpretation bolsters our arguments that O&P is fundamentally different from durable medical equipment, that prosthetists and orthotists are important members of the rehabilitation team, and that O&P practitioners’ clinical notes should be considered part of the patient medical records for purposes of determining medical necessity.
On the other hand, NAAOP is concerned that such an expansive interpretation of BIPA Section 427 will engender significant opposition from various stakeholders, increasing the likelihood of further delays, or perhaps leading to no final rule being published at all. We must not allow the proposed rule to become a pyrrhic victory. NAAOP believes that the purpose of BIPA Section 427 was, and is, to protect patients from unqualified practitioners and suppliers of custom O&P care, and to protect the integrity of the Medicare program from fraud, waste, and abuse. It was never intended to restrict patient access to care from health professionals who routinely provide specific types of orthoses with no established record of patient harm (e.g., hand orthoses provided by certified hand therapists).
The proposed rule was published by the former administration. The final rule faces a stiff headwind in the new regime, which is focused on lessening, not increasing, regulations on businesses and, in the healthcare arena, healthcare providers. NAAOP seeks to strike the right balance to ultimately secure timely publication of a final rule that works well for O&P patients, the providers who serve them, and the Medicare program.