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After lengthy discussions among NAAOP’s Board of Directors, O&P Alliance
organizations, and other stakeholder groups, consensus on the proposed rule
that interprets BIPA Section 427 is beginning to emerge. The Benefits
Improvement and Protection Act of 2000 (BIPA) Section 427 stated 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, 2017, CMS finally
issued proposed regulations on this provision in order 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, including physicians,
physical therapists, and occupational therapists. The proposed rule also
requires accreditation of all qualified suppliers by ABC, 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 membership 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 in order for health care professionals and suppliers to
provide complex and customized O&P care. This interpretation bolsters our
arguments that O&P is fundamentally different from DME, 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’s
medical record 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, regulation on business and, in the health care area, health
care 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.
Please visit our website at: www.naaop.org
NAAOP
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
www.naaop.org
