NAAOP Announces Unique Public Policy
and Advocacy Fellowship

ATTENTION ALL O&P CONSUMERS:  The National Association for the Advancement of Orthotics and Prosthetics (NAAOP) is soliciting applications for its inaugural health policy/advocacy fellowship. NAAOP is a national nonprofit association advocating for consumers/patients requiring orthotic and prosthetic care, as well as the providers who serve them.  The NAAOP Fellowship is a paid, 10-week summer program based in Washington, D.C.  The fellow will learn about orthotic and prosthetic (O&P) policy, advocacy, and how NAAOP and other O&P organizations function on behalf of the O&P community and within the broader rehabilitation and disability policy and advocacy community at the federal and state level.  The fellowship also includes exposure to (1) O&P clinical and business settings, and (2) state-based public policy and advocacy at no cost to the fellow.

One fellow will be selected for the summer of 2018 through a competitive process using the application on the www.naaop.org website.  The deadline to electronically submit this application is March 31, 2018 by 12:00 Midnight.  Three finalists will be interviewed via videoconference and one will be selected.  If the finalist selected cannot accept the fellowship for any reason, the next highest ranked fellow will be offered the position.

Selection CriteriaAll applicants must:

  • Personally use a custom fabricated orthosis or prosthesis;
  • Have an interest in public/health policy and advocacy;
  • Demonstrate an interest in advancing O&P care;
  • Have excellent writing, speaking, and analytical skills (see application for additional factors).

The NAAOP Fellow will receive a stipend of $500 per week.  NAAOP will provide the fellow with an office, phone, and computer in its offices at NAAOP’s counsel, the Powers Law Firm, 1501 M Street, NW, Washington, DC 20005.  NAAOP will assist the fellow in exploring inexpensive summer housing options with area colleges for those with no other housing options.  The NAAOP Fellow will be responsible for his/her housing costs.

The NAAOP Fellow will shadow NAAOP’s General Counsel, Peter Thomas, who will assign and oversee the fellow’s health policy and advocacy work.  That work will focus on O&P policy but also include exposure to the broader rehabilitation and disability policy environment.  Other O&P organizations will host the fellow for a day of activities.  The fellow will also be exposed to policy and advocacy speakers, attendance at Congressional hearings, participation in coalition and “think tank” meetings/presentations throughout Washington, and meetings with organizations in the broader rehabilitation and disability field.

Application Deadline:  12:00 Midnight, Saturday, March 31, 2018

Fellowship Selection Announcement:  By the end of April, 2018

Fellowship Term:  10-weeks (late May or early June through early to mid-August)

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Congress Passes O&P Clinical Notes Provision

In the early morning hours today, Congress passed and the President signed a massive budget agreement that sets budget levels for two years, continues to fund the federal government through March 23rd, and sets up a massive omnibus spending bill to fund the federal government through the remainder of fiscal year 2018.  One of the provisions in this bill directly impacts the O&P community:  Recognition of the prosthetists’ and orthotists’ clinical notes as part of the Medicare patient’s record for purposes of determining the medical necessity of O&P care.

ORTHOTIST’S AND PROSTHETIST’S CLINICAL NOTES AS PART OF THE PATIENT’S MEDICAL RECORD.

‘‘(5) DOCUMENTATION CREATED BY ORTHOTISTS AND PROSTHETISTS.—For purposes of determining the reasonableness and medical necessity of orthotics and prosthetics, documentation created by an orthotist or prosthetist shall be considered part of the individual’s medical record to support documentation created by eligible professionals described in section 1848(k)(3)(B).’’

This provision addresses a problem that started in 2011 with publication by CMS of a “Dear Physician” letter that stated that the physician’s notes, not the prosthetist’s, determine medical necessity.  This letter, and subsequent CMS guidance, resulted in a raft of unnecessary Medicare denials of O&P claims, many of which still sit at the ALJ level of review awaiting hearings.  The clinical notes of the prosthetist or orthotist will now be recognized along with the records of physicians and other professionals involved with O&P care.  NAAOP expects this provision to impact the reversal rate of Medicare O&P denials in favor of O&P practitioners at all levels of administrative appeal.

NAAOP congratulates and thanks AOPA and its lobbyists for their leadership on this provision, as well as NAAOP’s membership, the O&P Alliance organizations, the Amputee Coalition, and the ITEM Coalition, all of which worked to achieve enactment of this legislation.  NAAOP and the O&P community will continue the fight to enact two additional provisions from the Medicare O&P Improvement Act (S. 1191 and H.R. 2599), namely:

  • Section 7 of the Medicare O&P Improvement Act: This provision clarifies Congressional intent regarding the definition of “minimal self-adjustment,” which defines off-the-shelf orthotics for purposes of competitive bidding.
  • Section 8 of the Medicare O&P Improvement Act: This provision would direct CMS to finally implement long-overdue regulations for Section 427 of the Benefits Improvement and Protection Act of 2000 (BIPA), which links the right to bill the Medicare program for custom fabricated orthotics and prosthetics with the qualifications of the practitioner or supplier. This is an important fraud & abuse and patient protection.
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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.
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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.

  • Written by NAAOP

BIPA Section 427 Update and Other Health Care Developments

There were significant developments on health care issues this month, both broad and narrowly focused on O&P Care.  First off, the Senate was not able to muster a majority to pass the so-called Graham/Cassidy ACA repeal and replace legislation, which means that for the foreseeable future, persons in need of orthotic and prosthetic care will be able to access coverage under Medicaid and private, individual insurance.  This is because O&P care is typically considered an essential health benefit under the Affordable Care Act.  In related news, the House and Senate are moving closer to reauthorizing the Children’s Health Insurance Program (CHIP) for a 5-year period.  CHIP covers over 9 million children with health insurance that includes coverage of O&P care.

With respect to BIPA Section 427, CMS announced that it is “withdrawing” the proposed rule published on January 12, 2017, comments for which were due in March.  CMS received over 5,000 comments and the strongest objections came from physicians, PTs, and OTs, who arguably were exempted from the rule by statute.  By mandating that these providers obtain state licenses to provide O&P care or get certified by ABC or BOC, CMS generated tremendous opposition to the proposed rule.  In the end, these organizations overwhelmed CMS and were able to convince the Trump Administration to pull the rule in the name of regulatory relief.

There is no way paint a rosy picture of this development.  After years spent trying to finally get CMS to issue these regulations in final form, this is a significant step backwards.  However, there are some glimmers hope that we hope to build on.  First, the announcement stated that the rule was being withdrawn to “assure agency flexibility in re-examining the issues and exploring options and alternatives with stakeholders.”  We have already communicated with CMS and plan to meet with them soon to discuss how to proceed from here.

Second, this development heightens the need to rally behind passage of the Medicare O&P Improvement Act (S. 1191 and H.R. 2599) which includes provisions compelling CMS to finally issue regulations interpreting Section 427 of BIPA.  The bill explicitly exempts physicians, PTs and OTs, which would remove the majority of the opposition to the rule.  NAAOP will continue to work for passage of the O&P Medicare Improvement Act and seek alternative ways to implement the letter and spirit of BIPA Section 427.

  • Written by NAAOP

Congress Returns to Packed Legislative Agenda

Congress Returns to Packed Legislative Agenda

As Congress returns to Washington in the month of September, it faces a daunting set of challenges. The federal debt limit needs to be increased in order for the federal government to continue meeting its financial obligations. The federal government’s agencies need to be funded by October 1, 2017 or the government will shut down, and the State Children’s Health Insurance Program (SCHIP) needs to be reauthorized by the end of September or authority to run SCHIP will expire.

Complicating this packed legislative agenda is the need for federal funding to address the immediate and ongoing needs created by Hurricane Harvey.   The O&P community will be discussing the profession’s response to this colossal storm and seek ways to assist those impacted.  More to follow….

Several orthotic and prosthetic policy issues continue to be front and center for NAAOP.  CMS recently signaled that it may withdraw BIPA section 427 regulations linking provider and supplier qualifications with Medicare billing privileges. While it appears that CMS has not yet made a final decision, NAAOP and its Alliance partners are working hard to ensure that CMS presses forward with final publication of regulations involving this section of the law, which was passed 17 years ago but never implemented in full.

The Interagency Workgroup on Lower Limb Prosthetics, which was convened in the wake of the draft local coverage determination (LCD) for lower limb prostheses is expected to release a consensus statement at some point in the near future.  However, timing on this is still unclear. Once the Workgroup releases its statement, NAAOP will submit public comments on it.

Meanwhile, Congress continues to address O&P legislation by passing in the House legislation to recognize the relevance of prosthetists’ and orthotists’ clinical documentation as part of the patients’ medical records for purposes of determining the medical necessity of submitted claims. NAAOP is working with its Alliance partners to ensure that Congress passes this provision, along with other aspects of the Medicare O&P Improvement Act this year.

NAAOP also continues to work toward passage of the Injured and Amputee Veterans Bill of Rights, H.R. 2322, which is designed to educate veterans of their rights to quality O&P care and enable them to become their own best advocate in securing such care.

Finally, NAAOP acknowledges and congratulates AOPA on its 100th Anniversary, a true milestone.  We are also very proud to recognize our own 30-year anniversary as NAAOP. Our unending gratitude goes out to our members and supporters who have enabled us to speak on behalf of O&P practitioners and the patients they serve for the past three decades.

  • Written by NAAOP

Major Legislative Developments Impact O&P Care

Two major legislative efforts impacted orthotics and prosthetics in July as the House adjourned for their August recess and the Senate delayed their break to proceed to critical votes on other matters.

  1. ACA Repeal and Replace: The Senate debated whether to repeal and replace the Affordable Care Act at length and voted on several different versions of the bill.  Other than the “motion to proceed” with debate on the overall subject (which passed 51 to 50), all amendments were not able to attain the fifty votes needed for Vice President Pence to break the tie vote.  With all Democrats and Independents firmly against repeal and replace, Majority Leader McConnell (R-KY) could not lose more than two of the 52 Republican votes.  In the end, Senators Collins (R-ME), Murkowski (R-AK) and McCain (R-AZ) prevented the bill from proceeding and the Majority Leader was forced to pull the bill from consideration at 1:40 a.m., Friday, July 28th.  The main reason cited by these senators was the expected impact of coverage losses in their states.  This is a major development considering the long-standing call to repeal the ACA, but the effort to reform American health care will no doubt continue given the fragile condition of the private insurance market and the ever-growing federal investment in the Medicare and Medicaid programs.From an O&P perspective, failure of a repeal and replace effort temporarily removes a threat to O&P access and coverage across the private insurance market and Medicaid expansion programs.  There may be additional legislative efforts later this year as well as efforts that do not require legislative action.  For instance, the Secretary of Health and Human Services has significant authority to redesign regulations that impact the essential benefit package and the category of benefits known as “rehabilitative and habilitative services and devices.”  NAAOP expects proposed regulations in the near future that will give states much more flexibility in designing essential benefits, and O&P benefits are likely to be among the benefits that are limited or restricted in certain ways.  NAAOP will continue monitoring this situation closely to ensure maximum coverage of O&P care for the benefit of patients and their providers.
  1. Recognition of Clinical Notes of the O&P Practitioner: On July 25th, the House of Representatives passed bipartisan Medicare legislation, H.R. 3178, to recognize that “documentation created by an orthotist or prosthetist shall be considered part of the individual’s medical record to support documentation created by eligible professionals…”   This declaration will be tremendously useful in demonstrating medical necessity when Medicare contractors determine whether to deny O&P claims.  NAAOP recognizes and thanks AOPA for its extensive efforts on this achievement as well as the House sponsors including Glenn Thompson (R-PA), Mike Bishop (R-MI) and Mike Thompson (D-CA).  The bill now proceeds to the Senate where Senators Grassley (R-IA), and Warner (D-VA) have introduced the Medicare O&P Improvements Act, S. 1191, bipartisan legislation that includes this provision, as well as a number of other critical policy changes that benefit O&P.
  • Written by NAAOP

Congressional Briefing on the Value of Rehabilitation and Habilitation

Please see linked below the video to the entire one-hour Congressional Briefing on the Value of Rehabilitation and Habilitation Services and Devices in America’s Healthcare System held on earlier this week in the Dirksen Senate Office Building:

Table of contents

  • Peter Thomas begins the briefing
  • At 3:24, Senator Tammy Duckworth (D-IL) begins speaking
  • At 11:38, Representative Glenn Thompson (R-PA) begins speaking
  • At 23:58, Eric LeGrand begins speaking
  • At 32:53, Roseann Sdoia begins speaking
  • At 45:45, Lisa Smith begins speaking
  • At 51:06, Gregory J. O’Shanick, MD begins speaking
  • At 54:49, Peter Thomas begins the conclusion of the briefing

Thank you for your continued advocacy!

  • Written by NAAOP

SPECIAL ALERT:  Senate Health Reform Bill and Congressional Briefing

The Senate is scheduled to vote this week on its ACA Repeal and Replace legislation which was released in draft form on Thursday.  The bill would undermine essential health benefit coverage, including orthotic and prosthetic coverage, in the private insurance market and under the Medicaid program.

NAAOP is taking a lead role in working with a large group of rehabilitation and disability organizations to conduct a Congressional Briefing on the “Value of Rehabilitative and Habilitative Services and Devices in America’s Health Care System” along with over fifty Senate staff visits to drive home our message.

The briefing will be live streamed and will be available for viewing on NAAOP’s website at www.naaop.org.  The briefing is on Tuesday, June 27, 2017, from 12:15 to 1:30 p.m.  Special guests include Sen. Tammy Duckworth, Cong. Brian Mast, and others who will tell their story of injury, recovery, and the importance of rehabilitation services and devices.

  • Written by NAAOP