Saturday, May 18, 2024

Status of Congressional Medicare Reform


Key congressional committees in the House of Representatives are set to
consider their version of a Medicare reform package beginning this
afternoon. The House Medicare package, to be reviewed by the Ways and
Means Committee and the Energy and Commerce Committee today, includes a
provision that would subject off-the-shelf orthotic services and
virtually all durable medical equipment to a Medicare competitive
bidding program. The House bill does not include any form of a Medicare
payment freeze on orthotic or prosthetic devices.

House Republican leaders hope to bring a Medicare package to a full
House of Representatives vote by the July 4 recess.

Meanwhile, the Senate is currently debating its version of a Medicare
reform proposal that would freeze (i.e. provide a zero payment update)
Medicare non-custom fabricated orthotic service payments for a period of
seven years beginning in 2004. Prosthetics and custom-fabricated
orthotics would continue to receive annual Medicare payment updates
under the Senate proposal. The Senate package now being considered on
the Senate floor was approved by the Senate Finance Committee on a
bipartisan vote of 16-5 on June 12. DME payments (except for class III
devices) also would receive a zero update for the next seven years. The
Senate proposal does not include a competitive bidding program.

The full Senate will be debating its version of Medicare reform over the
next two weeks with an eye toward final approval by the July 4 recess.

If and when the full House of Representatives and the Senate are able to
pass their versions of Medicare reform, differences in the two packages
will be required to be reconciled by a conference committee. While it
is too soon to tell how these and other important issues to the O&P
community will unfold, AOPA will be working over the coming weeks and
months to minimize the impact of any legislative proposal on the O&P

Details of the House of Representatives Medicare Competitive Bidding
Program for Off-the-Shelf Orthotic Services

House definition of off-the-shelf orthotics: “Orthotics for which
payment is otherwise made which require minimal self-adjustment for
appropriate use and does not require expertise in trimming, bending,
molding, assembling or customizing to fit to the patient.”

Several other provisions of the House Medicare competitive bidding
proposal include:

***The Medicare competitive bidding program would be phased in over a
three-year period with at least 1/3 of competitive bidding areas
operating by 2005 and 2/3 of competitive bidding areas operating 2006.
The competitive bidding programs would target highest cost and highest
volume items and services first.

***Only contracted entities that have been selected by the Secretary
after meeting certain requirements would be permitted to provide
off-the-shelf orthotic devices in designated competitive bidding areas.

***Rural areas and areas with low population density within urban areas
that are not competitive would be exempt from a competitive bidding
program unless there is a significant national market through mail order
for a particular item or service.

***The Secretary may use competitive bidding reimbursement rates to
adjust off-the-shelf payment rates for areas that are not subject to
competitive bidding. In other words, the Secretary would be permitted
to reduce Medicare off-the shelf orthotic payment rates in
non-competitive bidding areas (i.e. rural areas) to the payment levels
that are established in competitive bidding areas.

***The Secretary may limit the number of entities in a competitive
bidding area to the number needed to meet the projected demand for items
and services covered under a contract. The Secretary would be required
to award contracts to multiple entities submitting bids in each area.

***The Secretary in consultation with a new Program Advisory and
Oversight Committee would establish quality, financial and consumer
service standards that will would apply to entities entering into
competitive bidding contracts. The Secretary would not be allowed to
contract with an entity if these standards are not met.

***The length of a competitive bidding contract would be up to a period
of three years.


American Orthotic & Prosthetic Association T 571.431.0876
330 John Carlyle St, Ste 200 F 571.431.0899
Alexandria, VA 22314

For more information, email us: [email protected]


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