Please view the link below for our video webcast – Big Changes Afoot at VA
and CMS.
Also, see link for CMS’s Proposed Prior Authorization for Certain O&P Care.
Changes Afoot at VA
Department of Veterans Affairs
Following over two weeks of withering criticism and speculation surrounding
the current state of the Department of Veterans’ Affairs health care system,
Secretary Eric Shinseki announced his resignation late last week. In a press
conference held on Friday, May 30, President Obama announced he had accepted
Shinseki’s resignation “with considerable regret,” lauding the former U.S.
Army General for his exemplary service and commitment to both our veterans
and our country.
The long-enduring problems associated with the VA health system were just
recently brought back into the public eye following the deaths of at least
40 veterans thought to be linked to excessive wait times at the VA hospital
system in Phoenix, Arizona. Over 40 other VA locations are being
investigated for these same problems. In addition, lengthy waiting times for
disability determinations and growing evidence of inconsistent health care
quality across the U.S. have fanned the flames of this scandal to the point
where significant changes are quite possible, including federal legislation
to create greater accountability in running the VA.
NAAOP continues to advocate for passage of the Injured and Amputee Veterans
Bill of Rights (H.R. 3408) which has over 35 bipartisan cosponsors in the
House, including several physicians and nurses now serving in Congress who
sit on the House VA Health Subcommittee. Enactment of this legislation would
not solve all of the problems with VA prosthetic care, but it would
certainly help veterans become their own best advocate to get the O&P
services and devices they need, when they need it. We encourage ALL NAAOP
members to contact their Member of Congress and encourage them to finally
act to protect and empower VA users of O&P care.
CMS Proposes Prior Authorization for Certain O&P Care
Please see this link from the Federal Register for CMS Proposes Prior
Authorization for Certain O&P Care.
CMS Proposed Rule on Prior Authorization
http://www.gpo.gov/fdsys/pkg/FR-2014-05-28/pdf/2014-12245.pdf
The Centers for Medicare and Medicaid Services (CMS) recently announced a
proposal to apply prior authorization to certain Medicare claims that are
frequently subject to “unnecessary utilization.” Expected to be on this list
are certain lower limb prosthetic components and related billing codes which
have been the subject of OIG and CERT reports in the recent past. A Master
List will be compiled by CMS using certain criteria that clearly indicate
that lower limb prosthetics will be subject, to some extent, to prior
authorization, assuming CMS does not reverse course or Congress does not
intervene.
While there is some controversy in the O&P profession as to the relative
benefit of prior authorization compared to the “pay and chase” model the
field has experienced for years, a clear consensus is emerging that there is
little in prior authorization that benefits patient care and will likely
lead to delays in access to prosthetic care for Medicare beneficiaries. It
is not a guarantee of payment, nor will it insulate providers from CMS
audits by RACs and other contractors. The proposed rule is full of policy
issues that must be analyzed and addressed, and NAAOP is doing its part to
conduct this analysis and seriously engage in this debate.
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
