Spring Brings Fever Pitch to O&P Policy Developments

There is no shortage of O&P issues on which NAAOP and its Alliance partners are actively engaged including publication of regulations on BIPA Section 427, separation of O&P from DME, implementation of prior authorization, the draft LCD for Lower Limb Prostheses, and the Administration’s proposal to expand competitive bidding to all O&P patient care. Recently, there has been major progress on moving our agenda. Former Senator Bob Kerrey, an amputee himself, has personally invested himself in preserving access to prosthetic/orthotic care and his support is helping to focus Congress and CMS on our priorities.

BIPA Section 427: The Benefits Improvement and Protection Act of 2000 (BIPA) included Section 427, which prohibits the Medicare program from paying for custom orthotics and prosthetics unless they are provided by qualified practitioners and suppliers. A supplier can qualify by being O&P licensed or accredited by ABC, BOC or an accreditor whose standards are “essentially equivalent.” The problem is that CMS never implemented this section of the law through regulation. NAAOP and the O&P Alliance have been fighting for years to get these regulations issued. But finally, the proposed regulations on BIPA 427 are pending at the White House, the final step before being issued for public comment. Once issued, we will analyze and respond forcefully to these regulations. The link between qualifications and Medicare payment of custom O&P care remains a priority of the profession, especially in the age of alternative payment models.

LCD Moratorium Legislation Introduced: On Monday, April 25th, Congresswomen Renee Ellmers (R-NC) and Jan Schakowsky (D-IL) introduced H.R. 5045, the Preserving Access to Modern Prosthetic Limbs Act of 2016. This bipartisan bill would impose a moratorium on issuance of the draft LCD, or any part thereof, until at least July 2017, instruct CMS and its contractors to remove the draft LCD from their websites, and clarify that CMS has authority to oversee the development of LCDs. NAAOP worked alongside AOPA and the Alliance organizations to get this bill introduced and strongly supports passage of the bill.

Veterans Access to Provider of Choice: Senator Burr and Senator McCain are promoting legislation to allow veterans to access private providers, outside of the VA system, on a permanent basis. NAAOP met with Senator Burr’s office to help ensure that his bill applies to veteran choice of prosthetists/orthotists. NAAOP submitted specific language to amend the bill, which would accomplish one of the key goals in H.R. 3408, the Injured and Amputee Veterans Bill of Rights. We will continue to update the profession as developments occur.

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