Contact your Senators/Representatives Today to Support the Medicare O&P Improvement Act

The House and Senate are seriously considering inclusion of key provisions of the Medicare O&P Improvement Act (S. 1191 and H.R. 2599) in the Medicare “extenders” legislation expected to be considered in the coming weeks.  The Medicare O&P Improvement Act is bipartisan legislation introduced by Senators Grassley (R-IA) and Warner (D-VA) and Congressmen Glenn Thompson (R-PA) and Mike Thompson (D-CA).  It is designed to improve the quality of patient care and treatment outcomes while limiting waste, fraud and abuse in the Medicare orthotic and prosthetic benefit.  There are a number of critical provisions in the act that should be included in the Medicare “extenders” legislation and passed immediately.

Recognition of Clinical Notes:  The House already has passed one of the provisions in the bill (Section 5) as part of the Medicare Part B Improvement Act (H.R. 3178, Section 103).  This provision would clarify that the clinical notes of the prosthetist or orthotist are considered part of the patient’s medical record, and will help establish the medical necessity of prostheses and orthoses provided to Medicare beneficiaries.

Linking O&P Provider Qualifications with Medicare Billing Privileges:  Section 8 of the Medicare O&P Improvement Act directs CMS to issue regulations on a section of the federal law that was enacted in 2000 but never implemented (BIPA Section 427).  Congress should enact this provision to require CMS to implement this federal law governing the qualifications necessary to provide custom-fabricated orthotics and prosthetics to Medicare beneficiaries.

Clarifying the Scope of Off-the-Shelf Orthotics: Congress exempted custom O&P care from DME competitive bidding in the Medicare Modernization Act of 2003 but permitted competitive bidding for “off-the-shelf” orthotics, defined in the statute as orthoses requiring “minimal self-adjustment.”  CMS subsequently issued regulations that dramatically expanded the scope of off-the-shelf orthotics, contrary to congressional intent.  Section 7 of the Medicare O&P Improvement Act would restore the original definition, protecting patients who require orthotic treatment by ensuring they receive the clinical services needed for orthoses to fit and function properly.

HOW TO HELP:  Go to www.naaop.org and access the Legislative Action Center.

  1. Use the template letter and amend it as you deem appropriate. Send three messages, one to your Congressman, and one to each of your Senators.
  2. Make three phone calls: Call your Congressman (202-225-3121) and follow the prompts to reach your representative.  Then call the Senate (202-224-3121) and ask to speak with each of your two Senators.
  3. MESSAGE:  Please actively support inclusion of the Medicare O&P Improvement Act in the Medicare “Extenders” Legislation currently pending in Congress.
  • Written by NAAOP

Veterans Choice of O&P Practitioner

Submit Comments by December 15th to Help Preserve Veterans’ Right to Choose

NAAOP asks its members and friends to take action by December 15th by submitting comments opposing the proposed Veterans Administration regulation to eliminate amputee veterans’ choice in selecting a VA prosthetist/orthotist or a private, VA-contracted prosthetist/orthotist, to provide their O&P care.  As currently drafted, the VA’s proposed rule found at this link (https://www.federalregister.gov/documents/2017/10/16/2017-22358/prosthetic-and-rehabilitative-items-and-services) could seriously erode veterans’ access to appropriate, timely and convenient O&P care.

For over fifty years, the VA has contracted with private practitioners to provide timely and quality O&P care to veterans with limb loss and other disabilities who honorably served our country.  These contractual arrangements offer veterans with amputations greater access to high-quality professionals, the newest technologies, and state-of-the-art laboratories where prostheses and orthoses are designed, fit and fabricated.  For years, private, VA-authorized O&P practitioners have played a vital role in augmenting the VA’s capacity to serve our nation’s veteran amputees and others with disabling conditions.

On October 16, 2017, the VA issued a proposed rule that would reverse this long-standing VA practice by insisting that the VA has the sole authority to determine whether a veteran can access a private O&P practitioner with a VA contract.  The proposed rule states that this is an “administrative business decision” without any reference to the importance of clinical circumstances of the patient.

This proposal would effectively deny veterans their right to select a prosthetist/orthotist of their choice, an important quality indicator and patient protection that has long been VA policy.  This proposal is striking because it runs counter to the key tenets of the Veterans CHOICE Program, which allows veterans to access VA-funded health care services in the private sector.

ACTION ALERT:  Please take action by December 15th by submitting comments to the VA opposing this proposed change in policy and asking the VA to maintain veterans’ right to choose their O&P practitioner, whether that practitioner is a VA employee or a private O&P practitioner with a VA contract.  Here is how you can help and thank you for your efforts:

  1. Click here to access a draft letter for practitioners to use in submitting comments.
  2. Click here to access a draft letter for your veteran patients to use in submitting comments.
  3. Modify the letter(s) to suit your own situation and add any additional comments you wish. Ask your veteran patients to participate.
  4. Go to this link, https://www.regulations.gov/comment?D=VA-2017-VHA-0023-0003 to electronically submit your comments. You have two options:
    1. Write “See attached letter” in the comment window and follow directions to upload your letter in PDF format; or,
    2. Copy and paste the contents of your letter into the comment window and hit send.
  • Written by NAAOP

O&P Legislative Call to Action! Help Build Support for O&P Priorities

In the wake of the O&P Policy Forum in Washington, DC, organized by AOPA, we ask all NAAOP members and friends to write to their Congressman and/or Senators to seek cosponsors for two important pieces of O&P legislation. Both bills have been introduced in previous Congresses but remain priorities for the O&P profession. We need to build cosponsors of these bills to get them moving through Congress. Here’s how you can help.

  1. Go to the NAAOP website at naaop.org and click on the Congressional Action Center. This will take you to two template letters, one for each bill.
  2. Follow directions within the site to send electronic versions of a letter to your Congressman on the first bill below and your two Senators and Representative on the second bill below. Modify the template letters to your liking and send them electronically to Capitol Hill asking them to cosponsor these bills.
  3. If you are able, please call the Capitol Switchboard at 202-225-3121 and ask them for your Congressman’s or Senator’s office. Ask to speak with the health legislative assistant and leave a message that you just sent them an email on important legislation and hope they will consider cosponsoring the bill(s).
  • Injured and Amputee Veterans Bill of Rights (H.R. 2322): This legislation is spearheaded by NAAOP and was recently introduced by Congressman Tim Walberg (R-MI). The VA Bill of Rights seeks to educate veterans of their rights to help them to become their own best advocate on their VA prosthetic care. This bill requires the VA to post a list of rights in every O&P clinic across the country as well as the VA website and include the right to obtain appropriate prosthetic technology, access the practitioner of the veterans’ choice, and to obtain a second opinion if the veteran disagrees with the VA prescribed treatment plan. All of these rights are consistent with the VHA Handbook and Congressional testimony presented by VA officials in recent years and should not cost the VA more than they currently spend on O&P services.
  • Medicare O&P Improvement Act (S. 1191 and H.R. 2599): The Medicare O&P Improvement Act includes important legislative proposals that would:
    • Recognize that the prosthetist’s/orthotist’s notes are considered part of the medical record
    • Separates DME from O&P in federal regulations
    • Directs CMS to fully implement Medicare law requiring O&P qualifications in  order to be reimbursed by the program for custom O&P care
    • Clarifies “off-the-shelf” orthotics to restore Congressional intent, and
    • Mandates that HHS refine its data on O&P audits and appeals to better track reversal rates and other important information throughout the appeals process.

Thank you for your efforts for the O&P profession and the patients we serve!

  • Written by NAAOP

VA Bill of Rights Reintroduced: Help Build Support!

NAAOP is pleased to announce that the Injured and Amputee Veterans Bill of Rights has been reintroduced in the 115th Congress as H.R. 2322! We thank Congressman Tim Walberg (R-MI) and several bipartisan cosponsors of the legislation from North Carolina for their support for this important legislation.

The Injured and Amputee Veterans Bill of Rights is not new legislation. It has been introduced in prior Congresses and even passed once in the House but did not make it through the Senate before Congress adjourned. The bill is designed to educate veterans with limb loss and other orthopedic injuries of their right to quality prosthetic and orthotic care. The bill requires the VA to prominently post a list of these rights in every VA prosthetic/orthotic clinic in the country, and on the VA website, so that veterans can become more aware of their rights and become their own best advocate for their care.

Despite the best intentions of many VA officials, too many veterans experience inconsistent care across the VA and are denied access to appropriate technology, the practitioner of their choice, a second opinion for prosthetic/orthotic prescription, and other safeguards. The Injured and Amputee Veterans Bill of Rights is designed to make O&P care provided under the VA system more consistent, raise awareness of O&P standards across the country, and empower veterans to ensure they receive quality care.

WE NEED YOUR HELP in attracting as many Congressional cosponsors as possible. Please contact your Representative and ask them to cosponsor H.R. 2322, the Injured and Amputee Veterans Bill of Rights.

  1. Go to the NAAOP Congressional Action Center. You will be able to take the template letter, amend it if needed, and send it to you Representative electronically.
  2. Please call your Representative’s office and ask them to cosponsor H.R. 2322. To contact your Congressman, call your local district office or dial the Capitol Switchboard in Washington, DC at 202-225-3121, provide your zip code and you will be routed to your Representative.

Thank you for your support of NAAOP and the Injured and Amputee Veterans Bill of Rights.

  • Written by NAAOP

O&P CALL TO ACTION

CALL TO ACTION!

Contact Your Senators and Urge Them to Cosponsor S. 829
The Medicare Orthotics and Prosthetics Improvement Act

NAAOP Needs Your Help Convincing Your Senators to Cosponsor S. 829. We urge you to take the following steps as soon as possible:

  1. Go to www.NAAOP.org and click on the Congressional Legislative Action Center. Click on the tab for S. 829/H.R 1530.
  2. Follow the steps outlined on the website. Take each template letter provided to the Senate and the House and customize them to your liking.
  3. When you hit “send,” your two Senators and Congressman will receive tailored email messages urging them to cosponsor S. 829 and H.R. 1530.
  4. Then, if you are willing, contact your two Senate offices by calling the Capitol Switchboard at (202) 224-3121, ask for each of your two Senator offices and speak (or leave a message) with health care staff urging cosponsorship of S. 829.

The Medicare O&P Improvement Act includes important legislative proposals that would:

  • Recognize that the prosthetist’s/orthotist’s notes are considered part of the medical record
  • Separates DME from O&P in federal regulations
  • Directs CMS to fully implement Medicare law requiring O&P qualifications in order to be reimbursed by the program for custom O&P care
  • Clarifies the meaning of “off-the-shelf” orthotics to restore Congressional intent, and
  • Mandates that HHS refine its data on O&P audits and appeals to better track reversal rates and other important information throughout the appeals process.

Action in the Senate is the most pressing. The Senate Finance Committee recently announced that they are interested in passing non-controversial, bipartisan bills that are in the jurisdiction of the Finance Committee, have been considered by the Committee and cost little or nothing. Those criteria precisely describe the Medicare O&P Improvement Act.

Former Senator Bob Kerrey’s involvement in this issue did not stop with the AOPA Policy Forum. He continues to actively volunteer his time, along with key AOPA and other O&P leaders, to get this bill passed into law.

You can do your part as an NAAOP member by participating in this process. Now is the time to help improve the O&P profession! Thank you.

  • Written by NAAOP

O&P Policy Forum and Separation of O&P from DME

NAAOP, in conjunction with the O&P Alliance, submitted formal comments last week on the proposed federal regulations to create a definition of the term “orthotics and prosthetics” in the Uniform Glossary of Medical Terms. This definition will be separate and distinct from the term, “Durable Medical Equipment.” The Uniform Glossary is a collection of commonly used insurance and medical terms that is intended to help inform the general public about its insurance plans and insurance options. Defining O&P separately from DME does not guarantee coverage of all O&P care in private insurance policies, but it will help consumers understand these benefits and will alert them to potential coverage, and coverage limitations and exclusions.

Not only will this separate O&P definition increase awareness of orthotics and prosthetics in private insurance, but it essentially breaks the connection between O&P and DME in these health plans. If the final rule is consistent with the proposed rule, strong arguments will exist to no longer apply DME limitations and exclusions on O&P services. And once consumers better understand what constitutes O&P care, they are likely to pressure plans into defining coverage under this benefit. While this victory does not impact the Medicare program, it represents the achievement of a long-standing goal that NAAOP has been waging, both independently and in concert with the O&P Alliance, since 2009, during Congress’ consideration of the ACA.

Please ATTEND the O&P Policy Forum

The O&P Policy Forum is fast approaching and NAAOP joins its Alliance partners in strongly encouraging leaders in the O&P profession to attend. AOPA spearheads the O&P Policy Forum each year and the Alliance organizations have promoted it for the past several years. It is a key opportunity for the O&P community to come to Washington, learn about the policies that impact the O&P professionals, and advocate on behalf of themselves and their patients.

This year, the Policy Forum will include an opportunity to help write legislation that can make a real difference. We are honored that Former U.S. Senator Bob Kerrey, himself a lower limb amputee, will participate in the forum by leading the effort to draft a bill, and will help advocate this bill on Capitol Hill. Your presence at the Policy Forum has never been more important!

Think about the challenges: The draft Lower Limb LCD, competitive bidding, prior authorization, and the list goes on and on. Come learn about these policies and bring your advocacy to your representatives in Washington. We strongly encourage you to attend and hope to see you in D.C. in late April.

O&P Policy Forum and Legislative Writing “Congress”
Tuesday, April 26th and Wednesday, April 27th (Arrive Monday night, April 25th)
Marriott Metro Center, Washington, D.C.
For more information, contact NAAOP or AOPA directly.

  • Written by NAAOP

BREAKING NEWS: Three New Developments Impact the O&P Community

Three new developments impacting the orthotic and prosthetic profession occurred on February 9th that NAAOP would like you to know immediately:

1. Rehabilitation Research Bill Advances in Senate Committee: On February 9th, the Senate Health Education Labor and Pensions (HELP) Committee reported favorably on a bipartisan bill introduced by Senators Kirk (R-IL) and Bennet (D-CO) to advance rehabilitation research, including O&P research and development, at the National Institutes of Health (NIH). The bill would enhance coordination and improve the stature and visibility of this research at NIH’s 27 Institutes and Centers, particularly in the National Center for Medical Rehabilitation Research (NCMRR). NCMRR’s mission includes O&P research and development. This occurred in 1990 after extensive lobbying efforts by NAAOP to increase O&P research funding at NIH. This is the first major piece of legislation to address the NCMRR at NIH since that time and should spark additional attention at NIH in this area. The bill now goes to the full Senate for consideration. A companion House bill has already been introduced by Congressman Langevin (D-RI) and Congressman Harper (R-MS)

2. DC Appeals Court Ruling Offers Hope to Providers on ALJ Backlog: The D.C. Circuit Court of Appeals issued an important opinion in the American Hospital Association’s administrative law judge (ALJ) delay lawsuit. The D.C. Circuit reversed the district court’s decision and determined that the court has jurisdiction over this case because HHS has a clear duty to issue ALJ decisions in 90 days, and “escalation” to the next level of administrative review is not an adequate remedy for HHS’s failure to issue ALJ decisions in a timely manner. The court remanded the case to the district court for it to consider whether to compel HHS to comply with the deadline in light of the worsening ALJ backlog. The decision gives some hope to Medicare providers, including O&P practices, that the intolerable delay in ALJ appeals will begin to be resolved, but the court did not yet actually step in and solve the problem. A decision by the district court is expected late this year.

3. President’s Budget Proposes to Expand Competitive Bidding to ALL O&P Care: For the first time, the President’s budget for FY 2017, released yesterday, proposes to expand DMEPOS competitive bidding to include ALL PROSTHETICS AND ORTHOTICS, in addition to a number of other types of DMEPOS. The proposal is expected to save $38 billion over ten years. This is bad news in that NAAOP and the O&P Alliance organizations will have to mount a strong defense against this proposal, but it is important to put this development into perspective. Competitive bidding for anything more than off-the-shelf orthotics is currently illegal, so Congress would have to pass a law authorizing CMS to expand it to all O&P care. This is the last year of the current President’s budget. The budget represents a grab-bag of policies that the administration throws out to gather reaction, and to pad the savings they can achieve in order to pay for their other proposed priorities. In this calendar year, there is no chance this proposal will become law absent titanic developments in Congress, which are not expected. Congressional Republicans declared the budget “Dead on Arrival” and have shown no interest in this specific proposal. NAAOP will work with its Alliance partners to strongly oppose this proposal, but it is certainly not immanent.

  • Written by NAAOP

September 2006 Action Alert

National Regulation/Quality and Qualifications

NAAOP, both individually and in partnership with other O&P organizations, has consistently sought to separate legislative and regulatory treatment of professional O&P care from the provision of durable medical equipment. These efforts have been largely successful through the years, witnessed by more favorable treatment for O&P in the area of Medicare fee schedule freezes and competitive bidding. These victories have been accomplished through years of persistence. In fact, there are now laws on the books that were written to protect Medicare beneficiaries from receiving substandard care from individuals who are not qualified to provide professional O&P care to Medicare beneficiaries. This battle was won because NAAOP and its allies in the O&P field finally convinced legislators that the provision of O&P care is complex, clinical, and critical for Medicare patients with orthopedic conditions and disabilities.

CMS regulators are now interpreting these laws as they relate to the establishment of quality standards and accreditation requirements. This matter deserves your attention because you and your patients will suffer if non-qualified suppliers are permitted to provide care to patients, and bill the Medicare program for it. It is again necessary to use the arguments that convinced legislators to press the case with regulators interpreting the statutes. To do this, the O&P profession must put a human face on the issue of quality standards and the adverse consequences of O&P patients receiving care from individuals not qualified to provide professional care

You may have the evidence needed to advocate for your patients and your profession. You can help! Please provide NAAOP with specific examples of the effect of non-qualified individuals providing O&P care. When providing these examples, please provide as much evidence as possible, giving facts, including timeframes, disclosing only what you know, and do not include information that would identify a particular patient. If you have questions, please call NAAOP at 800-622-6740 or e-mail us at info@naaop.org. We want to hear from you.

O&P is a relatively small profession and in order to compete in the larger healthcare arena we must continue to present a factual and compelling account of the threats facing O&P patients and professional O&P care.

Please share this information with a colleague.

Coverage and Reimbursement

DRA 9-Day Payment Hold
This message is for all providers and physicians who bill Medicare contractors for their services.

A brief hold will be placed on Medicare payments for all claims during the last 9 days of the Federal fiscal year (Sept 22 through Sept 30, 2006). These payment delays are mandated by section 5203 of the Deficit Reduction Act of 2006. No interest will be accrued and no late penalties will be paid to an entity or individual by reason of this one-time hold on payments. All claims held during this time will be paid on October 2, 2006.

Please note, however, that contractors handling large volumes of paper checks may have some difficulty putting all checks in the mail in a single day. Consequently, delivery of checks to providers may take a few extra days.

This policy only applies to claims subject to payment. It does not apply to full denials, no-pay claims and other non-claim payments such as periodic interim payments, home heath request for anticipated payments and cost report settlements.

Please note that payments will not be staggered and no advance payments will be allowed during this 9-day hold.
Please refer to:
MLN Matters article #MM5047; Change Request #5047; Transmittal# R944CP
or refer your questions to your FI/RHHI or Carrier

Thank you for your support.

Respectfully,

Mark DeHarde
President
George W. Breece
Executive Director
Peter W. Thomas
General Counsel
  • Written by NAAOP

NAAOP Action Alert

Dear O&P Professional:

The National Association for the Advancement of Orthotics and Prosthetics, both individually and in partnership with other O&P organizations, has consistently sought to separate legislative and regulatory treatment of professional O&P care from the provision of durable medical equipment. These efforts have been largely successful through the years, witnessed by more favorable treatment for O&P in the area of Medicare fee schedule freezes and competitive bidding. These victories have been accomplished through years of persistence. In fact, there are now laws on the books that were written to protect Medicare beneficiaries from receiving substandard care from individuals who are not qualified to provide professional O&P care to Medicare beneficiaries. This battle was won because NAAOP and its allies in the O&P field finally convinced legislators that the provision of O&P care is complex, clinical, and critical for Medicare patients with orthopedic conditions and disabilities.

CMS regulators are now interpreting these laws as they relate to the establishment of quality standards and accreditation requirements. This matter deserves your attention because you and your patients will suffer if non-qualified suppliers are permitted to provide care to patients, and bill the Medicare program for it. It is again necessary to use the arguments that convinced legislators to press the case with regulators interpreting the statutes. To do this, the O&P profession must put a human face on the issue of quality standards and the adverse consequences of O&P patients receiving care from individuals not qualified to provide professional care.

You may have the evidence needed to advocate for your patients and your profession. You can help! Please provide NAAOP with specific examples of the effect of non-qualified individuals providing O&P care. When providing these examples, please provide as much evidence as possible, giving facts, including timeframes, disclosing only what you know, and do not include information that would identify a particular patient. If you have questions, please call NAAOP at 800-622-6740 or e-mail us at info@naaop.org. We want to hear from you.

O&P is a relatively small profession and in order to compete in the larger healthcare arena we must continue to present a factual and compelling account of the threats facing O&P patients and professional O&P care.

Please share this information with a colleague.

Join your NAAOP colleagues in our efforts. Add your voice. Defend professional O&P patient care.

Respectfully,

Mark DeHarde
President
George W. Breece
Executive Director
Peter W. Thomas
General Counsel
  • Written by NAAOP