Court Poised to Compel HHS to Decide Medicare Cases within 90 Days

On October 3, 2016, the U.S. District Court for the District of Columbia held a status conference in the ALJ delay suit filed by the American Hospital Association (AHA) against the Secretary of Health and Human Services (HHS), Sylvia Burwell.  Judge James E. Boasberg stated that he will likely issue a writ of mandamus ordering the Secretary to comply with the 90-day deadline for deciding Administrative Law Judge (ALJ) appeals.  This clarified his earlier decision on September 19, 2016, where he declined to “stay” (i.e., delay) proceedings in AHA’s ALJ delay suit.  At the status conference, Judge Boasberg came as close as he could to confirming his intention to order mandamus, compelling the government to decide ALJ cases within 90 days.

Judge Boasberg scheduled expedited briefing on potential “remedies” to address the ALJ backlog, recognizing that he could not simply wave a magic wand to make over 750,000 pending ALJ appeals go away.  The judge is looking to issue in this case before the end of the year, but HHS implied that it would appeal to the D.C. Circuit Court, thereby delaying by several months a full resolution of this case.  Nonetheless, the District Court continues to exert tremendous pressure on HHS to make significant progress in reducing the ALJ backlog and the extentive amount of time it takes to resolve Medicare denials.

The status conference began with Judge Boasberg stating his view that it is not practical to order HHS to comply with the ALJ deadline within the next six months.  Instead, he asked the parties to suggest potential remedies for clearing the backlog.  Counsel for AHA suggested that HHS could settle more appeals than it is currently.  AHA also proposed that HHS waive recoupment and the assessment of interests against providers appealing cases.  Although this would not clear the backlog, it would lessen the harm from the delay.  AHA also stated that HHS should place greater limits on Recovery Audit Contractors and sanction them for incorrectly denying claims.

HHS responded that it is making progress toward clearing the ALJ backlog.  HHS reported that it has restarted the settlement program for inpatient status appeals (i.e., short inpatient stays)—the program that led to over 200,000 settled cases in 2014.  HHS stated that statutory constraints prevented it from adopting some of AHA’s suggested remedies.  HHS also requested briefing not only on potential remedies, but also on whether the court should issue the writ of mandamus at all.  HHS stated that it wanted to “preserve the record” on the mandamus issue, which implies that HHS intends to appeal any mandamus order to the D.C. Circuit.  The judge ordered briefing on both issues on an accelerated timeframe.  The first brief by AHA is due October 14th, the government responds on November 4th, and then AHA submits its reply brief by November 14th.  Again, a decision in the case is very possible by year’s end.

If the Court does decide to issue the mandamus order, the government is expected to appeal that decision to the Court of Appeals, again.  This will delay this case well into 2017, but given what the Appeals Court held the last time it reviewed this case, the demand to decide ALJ cases within 90 days is not likely to go away.

  • Written by NAAOP

Major Victory on Medicare ALJ Hearing Backlog

On September 19, 2016, the U.S. District Court for the District of Columbia declined to delay proceedings in the ALJ backlog suit filed by the American Hospital Association (AHA) against the Secretary of Health and Human Services (HHS), Silvia Burwell. The court gave strong signals that it will likely order the Department of HHS to comply with the 90-day statutory deadline to decide Administrative Law Judge (ALJ) appeals, but stopped short of doing so in its opinion. Instead, it called for a status conference with the litigants to discuss the matter further on October 3rd.

AHA filed suit in 2014 against the Secretary of HHS, seeking a “writ of mandamus,” which is an order directing a government official to comply with a duty. Here, the duty is to decide ALJ appeals within 90 days as required by the Medicare statute. In December 2014, the court dismissed AHA’s suit. The court believed at that time that the extensive delays in ALJ decisions should be addressed by HHS and Congress, not the courts. AHA appealed to the D.C. Circuit Court of Appeals.

The D.C. Circuit reversed the district court. The D.C. Circuit held that AHA satisfied the core requirements for mandamus jurisdiction because hospitals have a clear right to ALJ decisions in 90 days; the Secretary has a clear duty to decide ALJ appeals in 90 days; and hospitals [as well as all other providers] have no adequate alternative remedy other than mandamus. The D.C. Circuit noted that the ALJ backlog is having a real impact on human health and welfare because some providers are admitting fewer cases that are likely to be targeted by Recovery Audit Contractors (RACs). The D.C. Circuit remanded to the district court, however, to determine whether Congress and the Secretary are making “significant progress” toward solving the ALJ backlog.

The Secretary’s first action on remand was to request that the district court stay—delay—proceedings for seventeen months, until September 30, 2017, arguing that the agency’s initiatives and legislation pending in Congress would clear the backlog without judicial intervention. AHA opposed the stay under the theory that the Secretary’s initiatives would actually result in an increase in the ALJ backlog unless Congress provides substantial additional funding, which is unlikely. Although this case was brought by the American Hospital Association, the ultimate decision of the court in this case will apply equally to all providers and suppliers who serve Medicare patients, including orthotists and prosthetists.

On September 19, 2016, the district court denied the Secretary’s motion to stay. Although the court did not formally decide whether to order the Secretary to comply with the deadline, the judge did weigh factors for and against the issuance of a mandamus order when analyzing whether to grant the stay. In other words, the judge was clear that the outcome of the motion would indicate whether or not he would grant the writ of mandamus. In the Secretary’s favor, he noted the intrusiveness of a writ of mandamus and the Secretary’s assurances that solving the backlog is a high priority. The court also cited Congress’s awareness of the ALJ delay.

Ultimately, the District Court determined that the factors in favor of a writ of mandamus outweigh the factors against. The court agreed with AHA that the Secretary’s current initiatives would not solve the ALJ backlog and would actually result in it growing over time. The court emphasized that “significant progress toward a solution cannot simply mean that things get worse more slowly than they would otherwise.” The court also faulted the Secretary for not exercising greater control over the RAC program.

The court concurred that Congress is unlikely to solve the backlog. The court pointed out that the House and Senate Budget Committees have refused to hold hearings on the President’s 2017 budget, which would provide significant additional funding for ALJs. The court also stated that lack of action on the AFIRM Act to date shows that this bill is unlikely to relieve the backlog in the near term.

Analysis

For all these reasons, the court denied the motion to stay, and at the same time, the court strongly implied that it will order HHS to comply with the ALJ deadline. The court stated, however, that it cannot simply waive a “magic wand” to eliminate the backlog. The court scheduled a status conference for October 3, 2016 “to discuss how to proceed.” NAAOP will attend that status conference and provide our members with an update following that conference.
While this decision will not solve the ALJ backlog overnight, it is a very important decision that will place tremendous pressure on CMS to meaningfully address the over 750,000 cases it has pending at the Office of Medicare Hearings and Appeals. This means that O&P practitioners and facilities that have Medicare claims pending at OMHA will likely begin to see some relief from the lengthy delays in getting their ALJ appeals heard and decided. However, the question of when this will occur still remains uncertain. We will be closely monitoring this situation as developments occur.

  • Written by NAAOP

“Bundling” is Coming to a Hospital Near You

“Bundling” is a concept that is sweeping across the Medicare program and will eventually have significant implications on orthotics and prosthetics. The Secretary of Health and Human Services recently announced that by 2018, 50 percent of Medicare patients will be in “alternative payment methods” or “APMs” rather than the fee for service program. Bundling is considered an APM. There are many forms to bundling and the Centers for Medicare and Medicaid Services (CMS) is doing its best to accelerate this trend.

BCPI: The Bundled Payments for Care Improvement Initiative sits under the Centers for Medicare and Medicaid Innovation (CMMI). This is a program that essentially experiments with APMs and number over 1,500 different models at the current time. Hospitals and hospital systems across the country have entered into arrangements with CMMI to provide care for certain patients with particular conditions outside of the fee for service payment system. In many instances, these models establish certain quality indicators, cap payments, and reward providers who save money (compared to the fee for service payment system) by sharing the savings with them. The intention is to study different methods of Medicare payment and make permanent those that are successful in improving quality and decreasing cost. Although this program has been under way for several years, there is little public information that describes which programs are most successful and which have failed.

Mandatory Bundling: Late last year, CMS issued a proposed rule to establish a mandatory bundling program for hip and knee joint replacement patients in many cities across the country. Known as the Comprehensive Care for Joint Replacement bundled payment system (CJR), this program took effect on April 1, 2016. Much like the BCPI programs, the CJR establishes quality indicators and compares expenditures of a joint replacement episode of care to the cost of similar care under the fee for service program and rewards providers who more efficiently provide that care. Because the program is so new, there is no real information that evaluates patient outcomes or whether savings are being achieved. This is the first mandatory bundled payment system under the Medicare program and serves as a template for other mandatory bundling programs. In fact, CMS recently announced a proposed rule to similarly bundle cardiac care. That same proposed rule expanded the number of conditions under the CJR bundling payment system.

There are many other forms of bundling as well including Accountable Care Organizations, Shared Savings Programs and even managed care arrangements under the Medicare Advantage program. In short, bundling is here to stay and the O&P profession must carve a path into bundled payment systems to ensure continued patient access to quality O&P care. Unfortunately, this path is not clear. Bundled payment systems are typically time limited, usually a 90-day episode of care. So, for instance, new amputees would likely be outside of the bundled payment episode once they are fully ready for a definitive prosthesis. This may also be true, though to a lesser extent, with custom orthotics. But the referral to a particular provider may very well be established within that initial 90-day window. Therefore, O&P practices across the country must figure out how their local market is reacting to bundling and engage hospitals, health systems, managed care organizations, ACO’s, and other bundled payment entities to find their rightful place in these alternative payment models.

  • Written by NAAOP

Follow Up on S. 829 and New Proposed Regulations on Medicare Appeals

829 Follow Up: The Medicare Orthotic and Prosthetic Improvement Act (S. 829) continues to gain cosponsors in the Senate, thanks to the efforts of O&P practitioners and patients across the nation who have been contacting their members of the U.S. Senate asking them for support. NAAOP members have done their part in reaching out to key Senate offices seeking additional support for this important legislation. The bill would recognize the clinical notes of the O&P practitioner as part of the patient’s medical record, separate DME from O&P, and accomplish a number of other important O&P policy improvements. If you have not yet contacted your Senators, we ask you to do so now. Just go to www.NAAOP.org and click on the Legislative Action Center. The July webcast provides detailed instructions to assist in accomplishing this important task.

We now ask you to go the extra mile and invite your Congressman and Senators to visit your clinic during this political season. All Members of Congress and one third of the Senate are up for reelection in this election cycle and ALL of them are actively looking for ways to meet constituents, align themselves with attractive human interest stories, appeal to voters, and gain unpaid media attention. There is no better way to do this than to visit an O&P clinic, tour the facility, and meet patients whose lives have been touch by O&P care. CONTACT your Congressman and Senators today and request to schedule a visit at your clinic during the month of August, early September and in the weeks leading up to the November election. There is no better time to help develop O&P champions through this one-on-one advocacy.

Proposed Regulations Issued for Medicare ALJ Appeals: In early July, the Office of Medicare Hearings and Appeals (OMHA) issued new regulations that propose to make significant changes to the Medicare administrative appeals process. Most of these changes are detrimental to providers but some are more positive. The regulations were presumably issued to try to address the deepening appeals crisis. There are over 750,000 appeals pending at the OMHA and the agency has capacity to resolve only 77,000 cases each year. This means a 10-year backlog of cases, and the denials and related appeals keep entering the system faster than they can be resolved. The average time for an ALJ appeal to be decided is reported by OMHA as 832 days, despite the statutory requirement that such decisions occur within 90 days. In short, the situation is unsustainable.

NAAOP is working with the O&P Alliance to file comments on these proposed regulations by the deadline on August 29th. We are opposed to the proposal to make the 90-day deadline for ALJ decisions permissive rather than mandatory, as the statute requires. We also oppose granting authority to the Medicare Appeals Council (MAC) to pick and choose which cases will have precedential value, meaning if one case is denied at the MAC, similar cases in the appeals backlog may also be denied. Finally, we support other provisions in the proposed rule that would make it easier for providers to get a fair hearing and not be overwhelmed by Medicare contractors in the course of the ALJ hearing itself. In short, we will seek to protect the interests of O&P providers and the patients we serve in the context of this proposed regulation.

  • 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

Major Developments in O&P Research Priorities, Policies and Funding

NAAOP’s roots center on the issue of O&P research and development. In 1987, a small group of O&P leaders believed the field needed to develop a funding stream for O&P research activity and NAAOP’s predecessor organization, the American State of the Art Prosthetic Association, was born. The organization focused on introduction of the Claude Pepper Act for Amputees, which was eventually merged into the National Institutes of Health (NIH) Reauthorization Act of 1990. That law created a program at NIH known as the National Center for Medical Rehabilitation Research (NCMRR). The mission of the center is to “conduct and support medical rehabilitation research, including orthotic and prosthetic research and development.” The center has supported O&P research ever since, primarily through the Small Business Innovation Grant (SBIR) program, but also through more traditional NIH grants usually secured by large research universities.

NIH: Recently, twenty five years after passage of this law, NIH held a two-day rehabilitation research conference where nearly 500 people participated. O&P research priorities were discussed in the context of rehabilitation science. O&P research was clearly at the table and held its own in a manner that could not have been imagined 25 years ago. This conference will help NIH update its research priorities, which have not been updated since 1993. This conference and the research plan update were, in part, prompted by advocacy by the Disability and Rehab-ilitation Research Coalition (DRRC), a 43-member coalition in which NAAOP participates.

Interagency Committee on Disability Research (ICDR): DRRC was also successful in getting Congress to direct another federal entity, the ICDR, to develop a government-wide strategic plan for rehabilitation, disability and independent living. That broader effort is being conducted simultaneously with the NIH research plan process. Within the next few months, the federal government is expected to have two major documents that prioritize, coordinate, and elevate the stature of rehabilitation and disability research, with a meaningful focus on O&P research.

Evidence-Based Medicine: This is critical in that all of health care is moving at a rapid pace toward evidence-based medicine and evidence-based practice. A sufficient evidence base will be necessary in the future to secure coverage of O&P services that are often taken for granted today, and the research efforts of today will help pave the way to this. The O&P community has been proactive about evidence development for some time. Two research foundations were established by AOPA and the Academy. AOPA secured a large federal appropriation to fund O&P research through the Department of Defense, and the Academy developed consensus around a set of O&P research priorities as well as other efforts.

Washington Meetings with Research Agencies: The timing, therefore, could not be better for the next Alliance activity planned for mid-June. O&P researchers and Alliance leaders will meet with the heads of five different federal agencies responsible for funding O&P research over a two-day period. The agencies include NIH, ICDR, the National Science Foundation, the Department of Defense, and the Veterans Administration. The goal of the meetings is to further develop relationships with these funding agencies and exchange information on priorities and research portfolios. NAAOP will continue to keep you apprised of developments in this area.

  • Written by NAAOP

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.

  • Written by NAAOP

Help Impose a Moratorium on Medicare’s Draft Lower Limb Prosthetic LCD – Ask Your Representative to Co-Sponsor H.R. 5045 Today!

H.R. 5045, introduced by Reps. Ellmers (R-NC) and Schakowsky (D-IL), addresses the July 2015 Medicare Administrative Contractor (DME MAC) proposed draft LCD for prosthetic limbs (DL 33787) that would completely rewrite the coverage rules for prosthetic limb care for Medicare beneficiaries with limb loss. The new coverage policy was so restrictive that it would have sent amputees back to a 1970’s level of care. This draft LCD was not based on any credible evidence, would seriously restrict access to modern prosthetic limbs, and was widely criticized by patients, prosthetists, physicians and numerous beneficiary and clinical organizations. Under these proposed policies, beneficiaries would be eligible for prosthetic limbs that are functionally outdated, less durable and less safe.
H.R. 5045 is bipartisan legislation that would:

  1. Place a moratorium on issuance of this draft LCD (or any part of it) until spring of 2017, after a new administration is in office;
  2. Instruct CMS and the DME MACs to remove the draft LCD from their websites to eliminate the risk of private insurers adopting this misguided coverage policy; and,
  3. Clarify that CMS does, in fact, have the authority to provide guidance and oversight of LCDs developed by Medicare Administrative Contractors.
  4. safe.

Ask your Member of Congress to Co-Sponsor H.R.5045 and help protect access to modern prosthetic care for Medicare beneficiaries and others with limb loss. You may contact your Member of Congress at this link: http://capwiz.com/naaop/issues/alert/?alertid=71698631

  • 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

Separation of O&P from DME in Private Health Plans

On February 26, 2016, three federal agencies responsible for regulating the Affordable Care Act announced a proposal to add a new definition of the term “orthotics and prosthetics” to the “Uniform Glossary of Coverage and Medical Terms” (“Uniform Glossary”), separate and distinct from the definition of durable medical equipment (“DME”). This had been a goal of NAAOP as well as the O&P Alliance since 2008, even before passage of the ACA.

The Uniform Glossary is a collection of standard definitions of medical and insurance terms that assist individuals in understanding their private health insurance options. The document is written at an elementary level, so as to be understood by the vast majority of the public. Inclusion in the Uniform Glossary does not guarantee coverage of orthotic and prosthetic (O&P) services but it does help consumers understand what constitutes O&P coverage and assists them in comparing and contrasting levels of such coverage across competing health plans. It also formally signals separate treatment from durable medical equipment (DME) in private health plans.

A new definition of orthotics and prosthetics in the Uniform Glossary will stimulate consumers to ask questions about the extent of private plan coverage of O&P care. It can be used to argue that DME caps of one sort or another do not apply to orthotic and prosthetic services, and it may prompt health plans to collect better data on O&P benefits and better define coverage of this important benefit.

Orthotics and Prosthetics Definition
The proposed regulation adopts a version of a definition that NAAOP and the Alliance recommended in numerous comment letters over the past six years, since enactment of the Affordable Care Act. The new definition of orthotics and prosthetics, as proposed in the Uniform Glossary, is as follows:

• Orthotics and Prosthetics: Leg, arm, back, and neck braces, and artificial legs, arms, and eyes, and external breast prostheses incident to mastectomy resulting from breast cancer. These services include: adjustments, repairs, and replacements required because of breakage, wear, loss, or a change in the patient’s physical condition.

Comments to this proposed definition are due on March 28, 2016, and NAAOP and the O&P Alliance will strongly support its adoption in the final Uniform Glossary. We may even offer some refinements to the definition, but the proposal to add this separate definition of orthotics and prosthetics is an important victory and should be strongly supported by the entire O&P profession and the larger rehabilitation and disability community. This will have an impact on all private insurance plans, not just ACA plans, and it will also strengthen the policy arguments for further separation of O&P from DME in both the Medicare and Medicaid programs.

  • Written by NAAOP