VA Choice of Practitioner and Medicare Competitive Bidding

Two major issues are heating up in Washington, veterans’ right to choose their O&P practitioner and Medicare competitive bidding of an expanded range of durable medical equipment, prosthetics, orthotics and supplies (DMEPOS).

VA Choice of Practitioner

The VA published a proposed rule in October making the VA the “sole” authority in choosing the O&P practitioner who will provide services to each veteran.  By doing so, VA proposes to fundamentally change the right that veterans have had for five decades to choose the O&P practitioner who best meets their needs, whether that practitioner is a VA employee or a private provider with a VA.  NAAOP strongly opposes this proposed change and will be working with its O&P Alliance partners to maintain veteran choice.

This “right” is included in the Injured and Amputee Veterans Bill of Rights (H.R. 2322), bipartisan legislation introduced by Congressman Tim Walberg (R-MI).  NAAOP is working with Cong. Walberg to advance the bill or, in the alternative, to try to impact the pending VA CHOICE 2.0 legislation.  This bill would make permanent the VA CHOICE program enacted several years ago.  The bill would expand veterans’ choice of private health care providers, exactly the opposite direction than the VA’s proposed rule on prosthetics.  Look for more information as to how NAAOP members can help on these issues in the coming days.

Expanding Medicare Competitive Bidding

On November 2, the Medicare Payment Advisory Commission (MedPAC) hosted a meeting entitled:  Medicare payment policy for non-competitively bid DMEPOS.  MedPAC staff opened the session by presenting the slide deck accessed here. MedPAC reviewed spending trends and pricing accuracy of non-competitively bid DMEPOS.  Staff indicated that across its top 25 DME items, Medicare spending rates had decreased about 50 percent since 2010 while, during the same period, non-CBP Medicare spending had increased by 24%, with no significant negative changes in beneficiary health outcomes.  (Many in the disability and rehabilitation community would argue this point.)  MedPAC’s staff stated that Medicare could have saved approximately $47 million in 2015 if Medicare rates were equal to median private payer rates for off-the-shelf orthotics alone.

The presentation concluded with the issuance of two policy options for the Commission to consider, one to expand the use of CBP to more items of DMEPOS, and to reduce payment rates for certain non-CBP products annually until they are in line with private rates. To protect beneficiaries from adverse balance billing practices, MedPAC recommended placing a cap on balance billing and paying non-participating suppliers 5% less than participating suppliers.  NAAOP will be monitoring this debate closely and will address significant concerns with MedPAC along with its Alliance partner organizations.

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