Year-End Update on Policies Impacting O&P Care

Spending Bill and ACA Repeal: As Congress heads toward the holiday Congressional recess, there is major unfinished legislative business to address, some of which has a direct impact on O&P providers and patients. An Omnibus Spending Bill is being negotiated to fund the federal government past the current deadline of December 12th. If Congress is not able to agree to a spending bill by that date, they will have to pass another short-term resolution to continue funding federal government programs until a longer-term compromise can be achieved. This week, the Senate is busy working to pass a Budget Reconciliation bill that would repeal key aspects of the Affordable Care Act. It is expected to pass the Senate with a simple majority vote but will be vetoed by the President.

Audits and Appeals: On the audit and appeals front, there is movement on the Senate Finance Committee’s efforts to streamline the RACs and the Medicare appeals process. Legislative language has recently been shared that would directly impact O&P audits and appeals in a very positive way. However, there are also a series of provisions in this draft bill applicable to all providers that would essentially erect barriers for providers to appeal claims denials. NAAOP is working in conjunction with AOPA and the O&P Alliance on this important legislation.

Inflation Update: The annual inflation update to the Medicare O&P fee schedule was released by CMS and, unfortunately, the lack of inflation created a negative update of .4 percent. This means that CMS will pay .4 percent less on January 1st on the O&P fee schedule than it is paying in 2015. This is based on a statutory formula created in 2010. In recent years, the formula created increases in inflation updates, but this year resulted in a negative update. Short of changing the federal law, there is not much that can be done to oppose these reductions in reimbursement for O&P or for any provider under the Medicare program. In addition, sequestration will continue to siphon an additional 2 percent off of all Medicare provider fees.

Draft LCD: The Draft LCD continues to be available on the CMS and DME MAC websites while CMS convenes an Interagency Workgroup to study the issue of prosthetic coverage and try to arrive at a consensus statement on the issue. This workgroup must be limited to federal employees by law and is expected to meet throughout 2016. CMS has recently confirmed that it is investigating whether it can remove the Draft LCD from its website while deliberations on this policy area continue. The agency remains committee to including robust public stakeholder input into this policy as it takes shape next year, but how that actually occurs is still under development. A meeting between CMS and NAAOP/the O&P Alliance is being scheduled for January to discuss next steps.

Heartfelt Thank You! 2015 has been an incredibly active year and one that witnessed extreme threats coupled with some of the most inspiring grassroots advocacy the O&P field has seen in years, perhaps decades. Patients came together with providers, manufacturers, and other health professions to defend access to appropriate O&P patient care. The O&P community should be proud of its collective accomplishments. NAAOP sincerely thanks all of its members and friends for their part in making this happen. Happy Holidays.

Contact Peter Thomas at 202-455-6550 or Peter.Thomas@ppsv.com for further information.