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.
- 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.
- 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.
- MESSAGE: Please actively support inclusion of the Medicare O&P Improvement Act in the Medicare “Extenders” Legislation currently pending in Congress.