Saturday, May 28, 2022

Fw: USA POLITICS/ Harkin Bill/ It’s the Law !

Anthony T. Barr

To set the record straight and for those of you that have an interest, = this is the federal legislation that was the result of AOPA and = congressional negotiations, AOPA recieved the delegated authority from = the Academy, to negotiate on their behalf.=20 I have condensed the forward to comply to the limit of 200 words for = OANDP.Those of you that want the complete text, contact me by private = e-mail. Tony

> H.R.5612
>=20
> Medicare, Medicaid, and SCHIP Benefits Improvement and Beneficiary =
Protection
> Act of 2000 (Introduced in the
House)
=20
> `(ii) DESCRIPTION OF CUSTOM FABRICATED ITEM- =20
> `(I) IN GENERAL- An item described in this =
clause is
> an item of custom fabricated orthotics
> that requires education, training, and =
experience to
> custom fabricate and that is included in a
> list established by the Secretary in =
subclause (II).
> Such an item does not include shoes and
> shoe inserts.
>=20
> `(II) LIST OF ITEMS- The Secretary, in =
consultation
> with appropriate experts in orthotics
> (including national organizations =
representing
> manufacturers of orthotics ), shall establish and
> update as appropriate a list of items to =
which this
> subparagraph applies. No item may be
> included in such list unless the item is =
individually
> fabricated for the patient over a positive
> model of the patient.
>=20
> `(iii) QUALIFIED PRACTITIONER DEFINED- In this
>subparagraph, the term `qualified
> practitioner’ means a physician or other =
individual who–
>=20
> `(I) is a qualified physical therapist or a =
qualified
> occupational therapist;
>=20
> `(II) in the case of a State that provides =
for the
> licensing of orthotics and prosthetics, is
> licensed in orthotics or prosthetics by the =
State in
> which the item is supplied; or
>=20
> `(III) in the case of a State that does not =
provide
> for the licensing of orthotics and prosthetics,
> is specifically trained and educated to =
provide or
> manage the provision of prosthetics and
> custom-designed or fabricated orthotics , and
> =
is
> certified by the American Board for
> Certification in Orthotics and Prosthetics, =
Inc. or
> by the Board for Orthotist/Prosthetist
> Certification, or is credentialed and =
approved by a
> program that the Secretary determines, in
> consultation with appropriate experts in =
orthotics
> and prosthetics, has training and education
> standards that are necessary to provide such
>prosthetics and orthotics . =20
> `(iv) QUALIFIED SUPPLIER DEFINED- In this =
subparagraph,
> the term `qualified supplier’ means
> any entity that is accredited by the American =
Board for
> Certification in Orthotics and Prosthetics,
> Inc. or by the Board for Orthotist/Prosthetist
> Certification, or accredited and approved by a
> program that the Secretary determines has =
accreditation
> and approval standards that are essentially
> equivalent to those of such Board.’.
>=20
>=20
> > SEC. 428. REPLACEMENT OF PROSTHETIC DEVICES AND PARTS. =20
> (a) IN GENERAL- Section 1834(h)(1) (42 U.S.C. 1395m(h)(1)), as =
amended by
> section 427(a), is further amended
> by adding at the end the following new subparagraph:
>=20
> `(G) REPLACEMENT OF PROSTHETIC DEVICES AND PARTS- =20
> `(i) IN GENERAL- Payment shall be made for the =
replacement
> of prosthetic devices which are
> artificial limbs, or for the replacement of any =
part of
> such devices, without regard to continuous use
> or useful lifetime restrictions if an ordering =
physician
> determines that the provision of a replacement
> device, or a replacement part of such a device, is
>necessary because of any of the following: =20
> `(I) A change in the physiological condition =
of the
> patient.
>=20
> `(II) An irreparable change in the condition
>=
of the
> device, or in a part of the device.
>=20
> `(III) The condition of the device, or the =
part of
> the device, requires repairs and the cost of
> such repairs would be more than 60 percent of
> =
the
> cost of a replacement device, or, as the
> case may be, of the part being replaced. =20
> (c) EFFECTIVE DATE- The amendment made by subsection (a) shall =
apply to
> items replaced on or after April 1,
> 2001.

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