Thursday, May 19, 2022

Legislation, Updates and the Future

David Schultz

I have read very carefully the posts from those within the field and thos=
e outside of the field relative to the new language that was recently pas=
sed and signed by the President. In an effort to enlighten the participan=
ts on this ListServ, I would like to present some facts regarding the pro=
visions for O&P in the recent Medicare legislation. =20

The recent AOPA legislative effort was not a unilateral decision by AOPA =
staff. It was studied, discussed, argued and approved by AOPA’s Governmen=
t Relations Committee and Board of Directors. The Board made the final ca=
ll. A Board made up of members such as yourselves. =20

Information about the proposal and its evolution has been reported in AOP=
A publications (The Almanac and AOPA in Advance), openly discussed at the=
AOPA Policy Forum (participation of which is open to all) and at both th=
e AOPA and AAOP annual meetings. Apparently some of you missed the multi-=
faceted open disclosure by AOPA and AAOP since there was no comment recei=
ved by the AOPA Board during or after the disclosure period. I would hav=
e thought that with the furor being raised now, one or more of you would =
have raised a red flag long before the language got to the passing point.=

Most of you who are complaining about the qualified provider language hav=
e failed to notice that the legislation also included a FULL CPI update f=
or O&P. This means that O&P will be receiving about $20 million more this=
year than in 2000. Since nobody has brought that up I have to assume the=
O&P LIST is just a forum to complain. I for one certianly appreciate the=
update. Especially in light of the fact that the update is much larger t=
han we could have ever expected.

One of the reasons O&P was granted a full CPI update is because of the qu=
alified provider language. By limiting who will be able to bill Medicare =
for provided O&P services, thereby limiting the fraud and abuse the Offic=
e of Inspector General (OIG) found in its investigations of custom orthot=
ics, Medicare saves a bundle of money. Those savings are being passed bac=
k to the O&P industry. =20

As to the misinformation that PTs and OTs are now going to able to provid=
e O&P. PT’s and OT’s have always been able to bill Medicare for O&P. Cong=
ress was not going to take that away from them. The PT and OT lobby is ju=
st too strong for us to overcome. =20

The qualified provider language was the direct result of the OIG investig=
ation into custom orthotics. Frankly, Congress is interested in two thing=
s – stopping fraud (i.e. saving money) and making sure that Medicare bene=
ficiaries have access to care. Members of Congress from rural states and =
districts were particularly concerned about the access to care issue – ar=
e there enough O&P providers to handle the growing number of patients. =20

Now with all of that said, those of you who have worked on state O&P lice=
nsure legislation know that it was or is necessary to include the PT”s an=
d the OT’s and probably a host of others including CPed’s, BOC’s, NARD’s,=
etc. in order to get a bill passed. This qualified provider issue is so =
like the state licensure bills. Although the goal was a pure piece of leg=
islation, compromise was the only route to any legislation at all. =20

The analogy is this – a farmer has a full silo of grain, there are 100 ra=
ts eating that grain. His choices are – eliminate most of the rats and ha=
ve the bulk of his grain to take to market to sell – or – let all the ra=
ts eat most, if not all of the grain. The AOPA Board’s position was to el=
iminate most of the rats.

You may not like some or all of this legislation, but you have to admit t=
hat it is a major accomplishment for a small provider community.

Lastly, I call your attention to two misconceptions that have constantly =
cropped up on the O&P List. One, there is no National Office any longer. =
That was disposed of about a year ago. There is an AOPA Officean AAOP off=
ice, an ABC Office and etc. but no National Office. =20

Secondly, the direction of the government relations activity of AOPA is n=
ot determined by the AOPA staff. While the staff does bring important mat=
ters to the attention of the Board and Government Relations Committee, it=
is the AOPA Board that makes the final decison on the direction to be ta=
ken. This was the case this time around and will always be the case in t=
he future. The AOPA Board, comprised of your members is charged with the =
direction taken in all matters pertaining to the management of the associ=
ation and its government relations iniative. So if you are going to compl=
ain about an issue why not complain to the Board and discard the all too =
often approach of dissing the staff. =20

David C. Schultz, CPO
AOPA – President Elect

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