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U.S. Politics: Protecting O&P on Capitol Hill
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American Orthotic & Prosthetic Association (AOPA)
Promoting the Business of O&P
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The O&P field faces a number of significant challenges in different legislative proposals recently approved by the House of Representatives and Senate. AOPA is implementing a coordinated legislative strategy to protect the interests of the O&P community and is working with other O&P organizations to ensure that the field sends a clear unified message to Capitol Hill.
The key components of the House/Senate legislative packages are outlined below.
AOPA is devoting all its resources to confront these serious challenges, including an organized grassroots effort, targeted lobbying, and the use of O&P PAC funds to get the O&P message across to lawmakers. Because of the magnitude of the issues and the short timeline before final House/Senate action, grassroots letters need to be generated quickly and in great numbers to be effective.
With the Congress in recess, the grassroots effort begins in earnest later this week and throughout July. AOPA will send Legislative Action Alerts containing the appropriate grassroots message and contact information to its membership and post the Alerts on this listserv.
If you have any questions regarding AOPA’s lobbying efforts or the legislative provisions affecting the O&P field, please contact Walter Gorski at (571) 431-0809 or at wgorski@aopanet.org.
***** K E Y I S S U E S F O R O & P *****
Last week, the House of Representatives and Senate approved different versions of the Medicare Prescription Drug and Modernization Act of 2003 (H.R. 1 and S. 1). Passage of these legislative measures now sets the stage for contentious deliberations by a congressional “conference committee” where senior lawmakers from the House and Senate will attempt to bridge the differences between the two legislative packages and develop a final bill to send to President Bush. House and Senate leaders along with the Bush Administration hope to complete action on this bill by the August Congressional recess.
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Key components of the Senate Medicare reform plan include:
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**Implementing a Medicare fee schedule payment freeze (zero update) on non-custom orthotic services for seven years. Custom-fabricated orthotic devices and prosthetic devices will continue to receive annual CPI-U updates.
**Establishing a three-year Medicare demonstration project that would permit physical therapists to treat Medicare patients without a prescription from a physician. Physical therapists would be permitted to self-refer Medicare patients for orthotic and prosthetic services if the demonstration is established in states where the state physical therapy practice act permits physical therapists to provide O&P services. This provision would also define a “qualified physical therapist” as one who is state licensed, thereby undermining the current O&P negotiated rulemaking process that is underway to define who is a qualified practitioner to provide certain orthotic and prosthetic services to Medicare beneficiaries.
**Requiring the Secretary of Health and Human Services to establish HCPCS L Codes for total body orthotic management devices used for the treatment of nonambulatory individuals with severe musculoskeletal conditions who are in the full-time care of skilled nursing facilities.
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Key provisions of the House of Representatives Medicare Reform plan include:
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**Establishing a Medicare competitive bidding program for off-the-shelf orthotic devices and virtually all durable medical equipment. Competitively bid rates would replace the Medicare fee schedule rates for those orthotic devices that meet the “off-the shelf” orthotic definition. While rural areas would be exempt from any competitive bidding program, the legislation would permit the Secretary of Health and Human Services to apply competitively bid reimbursement rates across the entire Medicare program.
**Moving Medicare payment of the therapeutic shoe benefits from a “usual, reasonable and customary” (UCR) payment system to the Medicare O&P fee schedule and permitting the Secretary of Health and Human Services to establish new payment rates for these services. Shoes and inserts would receive the annual O&P fee schedule updates rather than their current DME updates.
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American Orthotic & Prosthetic Association T 571.431.0876
330 John Carlyle St, Ste 200 F 571.431.0899
Alexandria, VA 22314 www.aopanet.org
Key Legislative Contact: Walter Gorski, (571) 431-0809
wgorski@aopanet.org
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