January has been a month of introspection for the O&P community as leaders in the profession have come together to discuss policy priorities and the path that lies ahead.
Medicare Lower Limb LCD: NAAOP and its Alliance partners will soon meet with CMS to discuss their plans for the Work Group being convened to study and recommend a consensus statement on lower limb prostheses. The Draft LCD was placed on hold by CMS last fall but it is not clear what will occur when the Work Group makes its recommendations. By law, the Work Group is comprised of federal employees only, so stakeholder input by the O&P and rehabilitation communities is critical as the Work Group deliberates on this important issue.
Prior Authorization of Prostheses: The final rule on prior authorization MAY impact as many as 84 lower limb prosthetic codes, but CMS will issue additional guidance before implementing this program. NAAOP and the Alliance members will continue to work with CMS as it determines which prosthetic codes, if any, will be subject to prior authorization and how they will implement this new process. Our first approach is to dissuade CMS from imposing prior authorization on prosthetic limbs and components at all. This new process is supposed to be targeted to Medicare benefits that are over-utilized, but recent Medicare data suggests a significant decrease in Medicare spending for prosthetic care in the past several years. If CMS does impose prior authorization on certain prostheses, we will stress to them that delays and denials are unacceptable for patient care and that transition to this new system must be as seamless as possible.
Injured and Amputee Veterans Bill of Rights: Please email us by clicking on “Contact NAAOP” on our website, www.naaop.org, to let us know your current experience with the Veteran Administration as you try to provide services to veterans in need of prostheses. Congresswoman Ellmers (R-NC) intends to soon reintroduce the Injured and Amputee Veterans Bill of Rights, which has been a long-standing priority of NAAOP. We need to hear your current experience in treating veteran patients. Do you confront barriers in gaining access to veterans in need of prosthetic care? Do you have an O&P contract with the VA? Do you experience long delays in gaining approval to provide prosthetic care to veterans? Please let us know your current experience with VA prosthetic care as we finalize our policy proposals to address problems and concerns in the O&P field.
O&P Congress and Policy Forum: Please plan to attend this year’s O&P Policy Forum on April 26th and 27th in Washington, DC. The policy forum is an annual event where leaders in the O&P profession come to Washington, DC to learn about O&P policies and advocate on behalf of patients and the providers who serve them. While AOPA organizes the policy forum, all Alliance organizations participate in this event, including NAAOP. This year, former U.S. Senator BobKerrey, a long-time friend of NAAOP, will lead an “O&P Congress” where we will all help draft legislation to address O&P policy priorities. We will then bring this bill to our legislators and promote our key priorities. NAAOP hopes to see you there!