Upcoming Proposed Rules impacting O&P

The Department of Health and Human Services recently released it’s semi-annual regulatory agenda that details all of CMS’s pending regulatory activity and their anticipated dates for publication. Several CMS rules of great interest to O&P are anticipated in the coming months and years:

In September of 2005, the Centers for Medicare and Medicaid Services (CMS) is expected to release the proposed rule for Medicare Competitive Bidding, which encompasses all Durable Medical Equipment and “off-the-shelf” orthotics. NAAOP worked diligently to ensure the most favorable definition of “off-the-shelf” orthotics in the final Medicare Modernization Act of 2003, but its interpretation and application by CMS will remain unclear until this rule is published. When the rule comes out, NAAOP plans a detailed analysis of the rule’s impact on professional O&P care and will draft comments as appropriate.

In November of 2005, CMS will release a proposed rule that will attempt to settle what constitutes a “qualified provider” for O&P services under the Medicare program. The outcome of this rule will ultimately settle the Negotiated Rulemaking process.

In December of 2006, HHS will release a final rule on the application of “inherent reasonableness” authority to all non-physician Medicare Part B payments—including O&P services. This rule has the potential to allow HHS and CMS to reduce reimbursement without significant notice and comment.

NAAOP will be monitoring the Federal Register diligently for the publication of these rules in the coming months and alert NAAOP members as appropriate.

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