Wednesday, July 24, 2024

VIEW NAAOP VIDEO AND UPDATE on “As ACA Repeal Vote Looms, O&P Issues Progress”


Please view our video webcast and update:

The House continues to struggle to achieve enough votes within the
Republican Party to repeal the Affordable Care Act (ACA) and replace it with
the American Health Care Act (AHCA). Despite extensive pressure on
Republican moderates, the House does not have enough votes at the present
time to pass the bill and send it to the Senate for further consideration.
Of greatest concern to House moderates is how the bill will impact those
with pre-existing conditions and those who rely on Medicaid for their health
care access. One of the biggest concerns for NAAOP is a recent amendment to
the AHCA that would allow states to opt-out of providing Essential Health
Benefits (EHB), which includes coverage for “rehabilitative services and
devices.” This language is why the vast majority of ACA health plans and
Medicaid expansion plans cover orthotics and prosthetics. NAAOP strongly
supports continued access to O&P care in any bill passed by Congress on
health reform.

As the ACA repeal debate continues, Medicare and other developments impact

. Injured and Amputee Veterans Bill of Rights: NAAOP is working to
reintroduce federal legislation to help educate veterans of their rights to
obtain O&P care under the VA health care program. The bill seeks to make
veterans aware of their right to select the practitioner of their choice and
to obtain appropriate prosthetic technology that meets their needs. A new
bipartisan bill is expected to be introduced soon.

. Performant Audits: The nationwide Medicare Recovery Auditor for O&P
claims (Performant) recently posted an approved issue on their website that
signaled a new round of audits on knee stance flexion, HCPCS code L-5845,
used with a wide variety of single axis knee codes. NAAOP and its O&P
Alliance partners view the approval of this audit issue as a major overreach
by Performant/CMS and have taken aggressive steps to oppose this issue and
request withdrawal of this audit approval. The audit would change current
Medicare coverage and coding guidance which RACs do not have authority to
do. Progress is being made as Performant recently removed the audit
announcement from its website without explanation.

. LCD Legislation: In 2015, the DME MACs issued a draft Local Coverage
Determination (LCD) for Lower Limb Prostheses (LLP) that would have
dramatically restricted access to the current standard of O&P care. That
draft LCD was placed on hold while CMS studies the issue through an
Interagency Workgroup on LLP. That debacle has contributed to the
reintroduction of legislation to change the LCD process. The Local Coverage
Determination Clarification Act, S. 794, was recently introduced in the U.S.
Senate and aims to make the LCD process more transparent and accountable.
(A House bill is under development.) The bill requires public notice and
comment and other processes to improve the development of LCDs, so
experiences like the LLP draft LCD do not occur again. Special thanks to
the Amputee Coalition for its leadership on this important bill. To send
your two Senators an email encouraging them to cosponsor the legislation, go
to the Congressional Action Center at

Please visit our website at:

1501 M Street, NW
7th Floor
Washington, DC 20005-1700
e-mail: [email protected]
(800) 622-6740
(202) 624-0064 Phone
(202) 785-1756 Fax


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