Tuesday, July 23, 2024

PLEASE VIEW NAAOP VIDEO – Follow Up on S. 829 and New Proposed Regulations on Medicare Appeals


Please view the link below for our video and update.

Follow Up on S. 829 and New Proposed Regulations on Medicare Appeals

S. 829 Follow Up: The Medicare Orthotic and Prosthetic 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 members of the U.S. Senate 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 DME from O&P, and accomplish a number of other important
O&P policy improvements. If you have not yet contacted your Senators, we ask
you to do so now. Just go to www.NAAOP.org and click on the Legislative
Action Center. The July webcast provides detailed instructions to assist in
accomplishing this important task.

We now ask you to go the extra mile and invite your Congressman 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
touch by O&P care. CONTACT your Congressman and Senators today and request
to schedule a visit at your clinic during the month of August, early
September and in the weeks leading up to the November election. There is no
better time to help develop O&P champions through this one-on-one advocacy.

Proposed Regulations Issued for Medicare ALJ Appeals: In early July, the
Office of Medicare Hearings and Appeals (OMHA) issued new regulations that
propose to 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 the OMHA
and the agency has capacity to resolve only 77,000 cases each year. This
means a 10-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 deadline on August 29th. We are opposed to the proposal
to make the 90-day deadline for ALJ decisions permissive rather than
mandatory, as the statute requires. We also oppose granting authority to the
Medicare Appeals Council (MAC) to pick and choose which cases will have
precedential value, meaning if one case is denied at the MAC, similar cases
in the appeals backlog may also be denied. Finally, we support 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, we will seek to protect the
interests of O&P providers and the patients we serve in the context of this
proposed regulation.

Please visit our website at: www.naaop.org


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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