CMS Expands Prior Authorization to Six Lower Limb Prosthetic Codes

On February 11, 2020, the Centers for Medicare and Medicaid Services (“CMS”) announced that six lower limb prosthetic Healthcare Common Procedure Coding System (HCPCS) codes will be subject to prior authorization as a Medicare condition of payment.  The six HCPCS codes (L5856, L5857, L5858, L5973, L5980, L5987) describe additions to three microprocessor-controlled prosthetic knees, a microprocessor-controlled ankle-foot prosthesis, and two prosthetic feet.  CMS officials stated that they do not plan any time soon to expand prior authorization to other O&P codes.

CMS will initially implement prior authorization for these codes in only four states—Texas, Pennsylvania, Michigan, and California—effective May 11, 2020.  CMS will then expand prior authorization nationwide beginning on October 8, 2020.  Once this requirement goes into effect, all claims associated with the six identified HCPCS codes that do not have provisionally affirmed prior authorization will be denied payment.  CMS intends to issue additional guidance regarding its deadlines to respond to prior authorization requests for the aforementioned prosthetic codes.

NAAOP has previously expressed concerns regarding the application of prior authorization to orthoses and prostheses.  O&P fabrication and fitting is a detailed, time- and labor-intensive undertaking that is critical to maximizing the beneficiary’s future function.  Unlike durable medical equipment, which is largely commodity-based, prosthetic care is clinical in nature and service-oriented.  Prior authorization has the potential to interfere with the provision of timely and appropriate care.  Any delay in the prior authorization process will directly result in further delays of treatment, and may led to denials of care.

However, prior authorization appears to remain a priority for the Trump Administration.  On February 10, 2020, President Trump released his fiscal year 2021 budget, which contained a proposal to expand prior authorization “to all Medicare Fee-for-Service items and services.”  Under the President’s proposal, CMS would target “items and services that are at high risk for fraud and abuse, such as inpatient rehabilitation facilities.”  At this time, CMS has not formally proposed a regulation that would implement this budget proposal expanding prior authorization, so it is not yet effective.

In fact, one day after the publication of the President’s Fiscal Year 2021 Budget, CMS Administrator Seema Verma seemingly contradicted the President’s proposal, noting that “[p]rior authorization requirements are a primary driver of physician burnout, and even more importantly, patients are experiencing needless delays in care that are negatively impacting the quality of care they receive.”  She stated that prior authorization has been indefensible for years and that she planned to reform or restrict prior authorization this year.  The inconsistent message strikes a discordant tone as CMS implements prior authorization of these six prosthetic codes.

NAAOP will continue to monitor the implementation of prior authorization to the affected prosthetic codes and update our members and friends as developments occur.

  • Written by NAAOP

O&P Advocacy in 2020: A Look Ahead

Happy New Year to all of NAAOP’s members and friends! As we begin the second session of the 116th Congress, a very busy agenda is expected in the coming months.

NAAOP Fellowship Applications Due January 31st
The third year of NAAOP’s Health Policy and Advocacy Fellowship is about to0 begin. Fellowship applications are due January 31, 2020. Two fellows who use custom orthotics or prosthetics will be selected to spend 10 weeks in Washington, DC this summer learning about O&P policy and advocacy in the broader context of health care and disability policy. We encourage all NAAOP members and friends to think of someone who might be interested and a good candidate and expose them to this opportunity. For more information and the application, please go to

O&P Leadership Conference
AOPA is hosting its annual O&P leadership conference for the weekend of January 10th. The Leadership Conference is a great way to kick off the year and activate the O&P community. With pending legislation in Congress, this will be a great opportunity to learn more about the Medicare Orthotics and Prosthetics Patient-Centered Care Act and how you can help pass the bill.

Medicare O&P Patient-Centered Care Act
Congress is working on lowering the cost of prescription drugs and reducing the impact of surprise medical bills. In addition, Congress extended certain Medicare payment provisions until May 22nd when these programs will expire unless they are reauthorized. This means that a Medicare bill is likely to be passed by this date, or at some point shortly thereafter. The O&P community has an opportunity to work hard to try to attach the O&P Patient-Centered Care Act to this legislation. If this is not possible, we also have an opportunity to perhaps have it included in a second version of the 21st Century Cures Act, informally known as “Cures 2.0.” This bill offers the O&P community another chance of getting the Patient-Centered Care Act included in a moving legislative vehicle, but only if we all come together and build strong support for passage of the legislation.

Veteran Choice of Practitioner
NAAOP, AOPA and the O&P Alliance worked together over the past several months to clarify that veterans continue to have a choice of their practitioner, whether that practitioner is a VA employee or is a sanctioned VA provider with a contract with the VA to provide O&P services to veterans. The Omnibus Spending bill for FY 2020 included some language on this issue but the direction to the VA was not as strong as it could have been. NAAOP will continue to work on this important issue in concert with AOPA and other Alliance organizations.

  • Written by NAAOP

NAAOP Announces 2020 Fellowships on Public Policy and Advocacy

ATTENTION ALL O&P CONSUMERS AND PRACTITIONERS:  The National Association for the Advancement of Orthotics and Prosthetics (NAAOP) is soliciting applications for its annual health policy/advocacy fellowship. NAAOP is a national nonprofit association advocating for orthotic and prosthetic patients, 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 environment at the federal and state levels. The fellows will also be exposed to policy speakers, attendance at Congressional hearings, and participation in coalition and “think tank” meetings/presentations throughout Washington.  The fellowship also includes exposure to O&P clinical practice and the business of O&P care.

Two fellows will be selected for the summer of 2020 through a competitive process using the application on the website. You can also download the DOCX file directly using the link below:

Download 2020 NAAOP Fellowship Application

The deadline to electronically submit this application is Friday, January 31, 2020 by 12:00 Midnight, Eastern Time.  Finalists will be interviewed via videoconference and two high quality candidates will be selected.  If the finalists 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).

NAAOP fellows each receive a stipend of $500 per week for a ten-week period, although the fellow will have paid time-off during Independence Day week.  NAAOP will provide the fellows with an office, phone, and computer in its DC offices at NAAOP’s counsel, the Powers Law Firm, 1501 M Street, NW, Suite 700, Washington, DC 20005.  NAAOP will assist the fellows in exploring inexpensive summer housing options with area colleges for those with no other housing options.  The NAAOP fellows will be responsible for their own housing costs but NAAOP housing subsidies may be available if necessary.

The NAAOP fellows will shadow NAAOP’s General Counsel, Peter W. Thomas, who will assign and oversee the fellows’ 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 fellows to understand their respective role and contribution to the O&P field’s policy framework.

Application Deadline:  12:00 Midnight, Eastern Time, Friday, January 31, 2020

Fellowship Selection Announcement:  March 4, 2020

Fellowship Term:  10-weeks (Monday, June 1 through Friday, August 7, 2020).

  • Written by NAAOP

Life in the Fast Lane of Washington, DC: Lessons and Experiences from the 2019 NAAOP Fellows

By Alicia Carver and Susannah Engdahl, PhD

This past summer, the NAAOP fellowship program doubled in size to host two fellows, due largely to the generosity of NAAOP donors. We were both very excited to participate this year, especially with the opportunity to work as a team and learn from each other’s experiences and skill sets. Between Alicia’s prior experience in advocacy and Susannah’s PhD in Biomedical Engineering, we formed a balanced and dynamic team. While the ten-week fellowship flew by in no time, we received an in-depth education in health and disability policy and advocacy, and learned more about continuing on this path in the future.

This summary is intended to provide donors with a first-hand account of our fellowship experience in hopes this vital program will continue to received necessary financial support.

Our Washington-based fellowship policy and advocacy experience included visits with all of the O&P Alliance organizations as well as attendance at the Amputee Coalition Annual Conference.  We embarked on a series of field trips throughout the country to gain exposure to the clinical, business, and state-based advocacy aspects of the O&P profession.  The fellowship gave us a comprehensive understanding of the vital roles and responsibilities that all O&P stakeholders play to improve the lives of people with limb loss and limb difference.

The bulk of our summer was spent learning about O&P policy in the context of broader healthcare and disability issues.  We spent days advocating on Capitol Hill on the Medicare Orthotic and Prosthetic Patient-Centered Care Act, which was being prepared for introduction in the 106th Congress.  These NAAOP-led meetings contributed to the legislative efforts of AOPA, which is spearheading the charge for this legislation, as well as the broader O&P Alliance. We were able to meet with 36 congressional offices and enjoyed an overwhelmingly positive reception. We both enjoyed sharing our personal stories in these meetings, since it helped to humanize the lives of orthotic and prosthetic users. (We had lots of chances to roll up pant legs/shirt sleeves and show off our prostheses!)

We also attended a meeting with key leaders at the Centers for Medicare and Medicaid Services (CMS) to discuss the definition of “orthotics” and argued that newly designed “powered” orthoses should be considered for coverage under the definition of an orthosis, despite a troubling trend at CMS to consider these new technologies as durable medical equipment (DME).  Finally, we met with a senior leader at the National Institutes of Health (NIH) who oversees the O&P research program at that federal agency.  We were inspired by the interest and focus NIH demonstrates toward the scientific advancement of orthotics and prosthetics.

Soon after the fellowship began, we met Peter Thomas, general counsel for the NAAOP, and George Breece, NAAOP Executive Director.  Their mentorship was invaluable to our fellowship experience.  We travelled to Michigan for our first “field trip” of the summer. We had the opportunity to shadow a number of fine practitioners throughout the summer, including at Stokosa Prosthetic Clinic and met members of the Michigan Legislature at the State Capitol building.

At the clinic, we were exposed to the clinical practice of prosthetics and learned about prosthetic billing as well as some of the procedures that the team follows when submitting insurance claims and appealing coverage denials. As individuals with limb loss ourselves, we both have patient experience with coverage denials and it was interesting to learn about coverage denials, appeals and billing issues from the provider perspective. Seeing the behind-the-scenes clinical and technical practice of prosthetics gave us a valuable perspective on O&P patient care.  Our time at the Michigan State Capitol building in Lansing provided a primer on state-based lobbying and illustrated the important link between clinical O&P practice and policy development that impacts O&P practice.

We spent a day with the Board of Certification/Accreditation (BOC) at its headquarters in Owings Mills, Maryland and were warmly welcomed by the entire BOC staff. We learned about the roles each staff member plays within the organization and the team mentality they all embrace. We were led through the process of Facility Accreditation and the important factors in that process.  We were inspired by the profession’s commitment to quality and how the accreditation organizations help the O&P community work together to achieve a unified goal.

We visited the American Academy of Orthotists and Prosthetists (AAOP) and sat in on a weekly staff meeting with their executive team.  We learned how the Academy compiles and maintains educational and research resources, such as the Online Learning Center, the Exam Preparation Seminars, and the Journal of Prosthetics & Orthotics, all of which enable members to stay up to date with new ways to meet patient needs.  As the O&P organization representing individual O&P practitioners, the Academy’s role cannot be overstated.

We then flew to Florida to visit the Gainesville Prosthetics and Orthotics clinic and the OPIE organization.  We learned the history of OPIE and spent the day with members of the OPIE team learning about electronic medical records in the O&P profession. In particular, we heard about the software development cycle, consumer experiences with software implementation, the knowledge-centered customer support system, and the OPIE Choice Network.

We also spent two days touring the Hanger Clinic in Laurel, Maryland and at the National Rehabilitation Hospital in Washington, D.C.  We were able to observe how the prosthetist used patient-reported outcome measures to assess the patient’s current functional status and evaluated the socket fit to determine if a new prosthesis was needed. At the National Rehabilitation Hospital, we saw firsthand how an O&P clinic operates when embedded in a rehabilitation hospital. After sitting-in on a patient visit and observing how modifications are made to a test socket, we toured the facility’s two therapy gyms and learned how the members of the therapy team coordinate with each other to maximize their patients’ functional outcomes.

We also traveled to Iowa to meet with the Orthotic Prosthetic Group of America (OPGA).  We learned how OPGA supports independent O&P practitioners by providing insurance, business management and marketing services, and by offering access to discounted O&P components, materials, and supplies from manufacturers and suppliers.  We also learned more about advocacy from several Iowa state legislators, including a former State Senator and former Iowa House Speaker.

We then met with the American Board for Certification in Orthotics, Prosthetics, and Pedorthics (ABC). They outlined the process for certifying practitioners and accrediting O&P facilities, as well as the role that ABC plays in overseeing these processes. We coupled this trip with a visit to the National Commission on Orthotic and Prosthetic Education (NCOPE), which taught us the role NCOPE currently plays in accrediting orthotic and prosthetic education programs, and in elevating the educational standards for practitioners in training.

We rounded out this trip by visiting the American Orthotic and Prosthetic Association (AOPA) which provided us with in-depth knowledge about AOPA’s collaborative efforts to advance the orthotic and prosthetic profession on behalf of O&P practices, manufacturers and suppliers.  Getting a better understanding of AOPA’s extensive government relations efforts, including the activities of their Political Action Committee, was extremely informative from a policy development standpoint.

Finally, we attended the Amputee Coalition Annual Conference in San Antonio, Texas.  We enjoyed a front row seat learning about new O&P technology and we both participated in several research projects in between sessions. We especially enjoyed the extensive networking opportunities to meet other amputees like ourselves.  The Amputee Coalition was particularly generous in affording us an opportunity to participate in multiple sessions as speakers, participants, and as consumer stakeholders.

As advocates, sharing our stories is one of the most powerful ways we can engage legislators and policymakers at the state and federal levels.  In these meetings, we as prosthetic and orthotic users turn from statistics and people in photographs to people with real needs, underscoring the importance of our message.  Being able to be mobile and live the life we want is a testament to the quality of care that orthotists and prosthetists provide. Our collective voice is the tool that will help us enact the legislation and regulation we need to thrive.

Reflections from Alicia

The fellowship experience has fueled my passion for advocacy and allowed me to look toward avenues that I might never have considered otherwise. I want to work hard and become a leader of the next generation. I have learned how critically important clinical research is, and about the gaps that exist in the O&P field.  We need more research to improve the evidence base of orthotics and prosthetics.  We need more data to help support legislation for the betterment of the entire O&P community. We also need more advocates on Capitol Hill who use orthoses and prostheses who “walk the walk” and serve as a living example of the value of O&P care.

We live using prosthetics and orthotics on a daily basis; our stories are powerful tools in this fight. This fellowship was a once in a lifetime opportunity to immerse myself into Washington D.C. I truly enjoyed the work I did this summer and I wholeheartedly urge others to apply for this opportunity if they have an interest in health policy and advocacy. I sincerely thank all those who contributed financially to make this fellowship a reality.  This past summer has made clear the path I wish to follow: adding to the army of advocates and future leaders in the O&P community.

Reflections from Susannah

This summer has been a fantastic experience and I’m very grateful that I had the chance to participate in the NAAOP Fellowship. I enjoyed being able to talk with so many people who work in diverse areas of the O&P community, in particular, Dr. Alison Cernich, the Director of the National Center for Medical Rehabilitation Research (NCMRR) at NIH. It was helpful to see how all of the policy areas we learned of complement each other—everyone has a different role to play, but their work ultimately comes together to advance patient care. This experience has energized me to look for ways to combine my previous skills as a researcher with my new skills as an advocate when I take the next steps forward in my career. Thank you so much to everyone who made this summer possible. I truly appreciate it!

Thank you to NAAOP, the organizations that hosted us, and, again, to those who supported the fellowship program through financial and in-kind contributions.

  • Written by NAAOP

Announcing New Board Members for 2020

NAAOP is proud to announce the election of five new members to our Board of Directors. These new board members were elected at the NAAOP Board meeting held in San Diego last month.

Rebecca Hast, the 2019 NAAOP President said, “I am pleased to let you know that NAAOP’s Board of Directors has unanimously agreed upon the addition of new board members beginning their one-year terms as of January 2020. We are particularly pleased with the varied backgrounds, rich experiences and energy each of these members will bring to our organization as we continue to strive to improve quality and fairness for patients and clinicians. Please join me in congratulating and welcoming our new board members.”

The new NAAOP Board members are:

Nathan J. Kapa, CP – Nate is presently the President of the Michigan Orthotics and Prosthetics Association and is a partner in Baranek & Kapa Prosthetics in Flint, Michigan. Nathan has been extremely active in O&P advocacy with the Michigan State Legislature and Michigan Congressional Delegation. Nathan is a graduate of Michigan Technological University and Northwestern University, Feinberg School of Medicine, NUPOC.


Nicole Ver Kuilen – Nicole lost her left leg below the knee to cancer at age ten. Nicole was the Inaugural NAAOP Fellow in 2018 and her documentary film, 1500 Miles has been honored by five international film festivals. Nicole was recently crowned National Champion at the 2019 Paratriathlon National Championships. Nicole is also the founder of Forrest Stump, a non-profit advocacy organization dedicated to raising the standards of care for all amputees.


Christian Robinson – Christian is Senior Vice President at Össur, responsible for the Össur Americas supplier business. Christian is a graduate from Brigham Young University and Harvard Law School. Since joining Össur in 2012, Christian has served in a number of executive positions, including General Counsel Americas and VP Finance Americas. Prior to joining Össur Christian practiced corporate law with global law firm Paul Hastings LLP with a focus on mergers and acquisitions and capital markets transactions.


Kevin A. Symms, CO, BOCPO, LPO – Kevin is a recognized subject matter expert and educator in medical device reimbursement and in providing technical and clinical support in the form of clinical documentation, medical necessity, pre-auth, appeal and ALJ. After a successful career in both Clinical and Executive positions with Hanger, Kevin started a Minnesota based consulting firm, OandPServe LLC, and he consults with Orthotic and Prosthetic providers and manufacturers nationwide.


Regina Weger – Regina is Vice President and General Manager of SPS, Inc., a distributor of Orthotic and Prosthetic products. Regina attended Brenau University and started her career in the Orthotics and Prosthetics industry in 1992 at JE Hanger Southeast in Alpharetta, Georgia. Regina is a member of the Executive Operating Team at Hanger, Inc., a 2015 recipient of the JE Hanger Leadership Award, and a leader/mentor for Women in O&P Leadership.

George Breece, Executive Director of NAAOP said, “we are very fortunate to have these O&P leaders joining our board in 2020. They each bring a wide breadth of real-life experiences which I know will help us continue to be a strong voice for quality O&P patient care on Capitol Hill, with CMS and the VA.”

  • Written by NAAOP

Limb Loss and Preservation Registry Begins to Take Shape

At the most recent AOPA National Assembly in San Diego, Kent Kaufman, Principal Investigator for the Limb Loss and Preservation Registry (LLPR) sough input from the O&P profession on his efforts to design and implement the registry from scratch. Earlier in September, Dr. Kaufman and his registry team convened the second meeting of a set of external stakeholders, established to provide advice to the registry team.

The two-day meeting was hosted by the world-famous Mayo Clinic in Rochester, Minnesota. A wide range of topics was discussed but the ultimate message was clear. In order for the LLPR to realize its promise, the entire O&P profession must embrace it, participate in it, and actively use it to help make clinical decisions and advise patients. As a profession, we have an incredible opportunity now that the Department of Defense and the National Institutes of Health have agreed to co-fund the development of this quality improvement registry for a five-year period. Collectively, we must succeed not only in developing a registry that offers real value to participants, but is sustainable once the federal grant money dries up. But how, exactly, can O&P clinicians, manufacturers, and patients help the registry succeed?

A quality improvement registry is a longitudinal database of clinical information on certain types of patients which is primarily used to improve care. Once developed, the goal is to have health care providers (and others) use the database to forecast pathways of care and expected outcomes; develop and improve clinical practice guidelines; obtain reliable incidence and prevalence data, and aid patients in making evidence-based decisions about their health care choices.

Phase I of the registry involves the selection of three beta sites that will collect a limited set of data, primarily from existing electronic data sources, and begin the process of building the database of clinical information on patients who seek to preserve their limb after illness or injury, or who have lost their limb, whether or not they seek prosthetic care. In fact, existing data suggests that between 50% and 70% of individuals with limb loss do not use prostheses, a phenomenon the registry should be able to help explain, or improve.

There will be only limited opportunities for manufacturers, O&P clinicians and patients to participate in phase I of the registry, which should last about one year. Phase II will engage the O&P community to a much greater extent. For instance, it will be important to work with manufacturers to better identify specific O&P components to match them with patient reported O&P outcomes. Practitioners will be key participants in collecting clinical data on limb loss and preservation patients as well as encouraging patients to fill out patient-reported outcome measures.

Demonstrating the value of participating in this endeavor is the real challenge. Most data will be collected through existing sources, such as the electronic medical record systems already in use throughout the country (although those relationships still need to be negotiated). The goal is to spare practitioners from inputting specific data on each patient for the purposes of the registry only. Another goal is to facilitate easy patient reporting of outcome data without erecting barriers to doing so. Much more information will be forthcoming once the registry begins to hit its stride, but everyone in the O&P community has a role to play to make the LLPR a success, and NAAOP encourages everyone to do just that.

  • Written by NAAOP

Congress Returns as MedPAC Discusses Expansion of DMEPOS Competitive Bidding

The U.S. House and Senate return to Washington this month to debate and pass a large number of appropriations bills that will fund the federal government for Fiscal Year 2020, which begins on October 1st.  In all likelihood, now that a budget agreement was reached in July, the bills will begin to move through Congress and be signed by the President, but it is likely a short-term continuing resolution will be necessary to allow them to finish this massive job.

In the meantime, CMS is accepting comments until September 27th on a proposed rule on Durable Medical Equipment, Prosthetics, Orthotics, and Supplies that changes how CMS sets reimbursement levels for new technologies and dramatically expands prior authorization of prosthetics and orthotics.  The full text of the rule, which also includes updates to CMS’ payment system for end-stage renal disease, can be found here, and a CMS fact sheet summarizing the major provisions in the rule can be found here.

Finally, on September 5th, 2019, the Medicare Payment Advisory Commission (MedPAC), an independent legislative branch agency that provides Congress with analysis and policy advice on the Medicare program, held a meeting that included a session titled Examining Competitive Bidding for Diabetes Testing Supplies and Expanding Medicare’s DMEPOS Competitive Bidding Program. A slide deck used to make the presentation can be found here.

The presentation provided an overview of the competitive bidding program (CBP) implemented under the Medicare Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) payment system, with a particular focus on the impact that CBP has had on spending and utilization for diabetes testing supplies. The presentation set the stage for a discussion of ways to expand the DMEPOS CBP throughout the Medicare program. The Commissioners offered questions and feedback on the presentation and the future of Medicare competitive bidding.

 MedPAC staff provided an overview of the two payment systems for DMEPOS items, the competitive bidding program and the fee schedule. Staff contended that many DMEPOS fee schedule amounts are “excessive,” and that the implementation of competitive bidding has resulted in “substantially” lower payment rates: among the 25 highest-expenditure products in 2017.  In fact, median payment rates declined nearly 50%.  Though MedPAC admits that utilization decreased for most product categories included in CBP, the Commission contends that CBP did not disrupt patient access, citing CMS data that shows no negative changes in beneficiary outcomes.  To further support the competitive bidding program, staff cited data demonstrating increased spending on non-CBP products.

The presentation also discussed the April 2019 Department of Justice enforcement action alleging a nationwide fraud scheme for off-the-shelf (OTS) orthotics, and posited that excessive fee schedule rates for these items likely encouraged the alleged abuse. Staff concluded the presentation by suggesting that the Commissioners and policymakers consider expanding CMS’s authority to include additional products in the CBP, specifically pointing to a list of candidate products identified by MedPAC in 2017.  NAAOP will continue to closely monitor competitive bidding and report to our membership as developments occur.

  • Written by NAAOP

Fellows Report Progress and Say Farewell While CMS Drops Alarming DMEPOS Proposed Regulation

The 2019 NAAOP Fellows, Alicia Carver and Susannah Engdahl, finished their fellowship last week and report learning a great deal about O&P policy and advocacy throughout the course of the summer.  NAAOP extends sincere thanks to the Alliance organizations for hosting the fellows, as well as numerous contributors and hosts across the country who exposed them to all aspects of orthotics and prosthetics.

Alicia Carver:  Alicia’s principal project this summer involved direct federal advocacy on the soon-to-be-introduced Medicare O&P Patient-Centered Care Act.  Alicia and Susannah joined forces to visit over 35 House and Senate offices to promote the policies in the bill and to seek cosponsors of the legislation.  The meetings focused on the three major committees of jurisdiction over the bill, the House Ways & Means Committee, the House Energy & Commerce Committee, and the Senate Finance Committee.  In fact, the fellows’ last meeting was conducted alongside OPGA’s lobbying team with the chief health staffer of Senate Finance Committee Chairman Charles Grassley (R-IA).  All of the hill meetings were coordinated with the O&P Alliance and with AOPA’s efforts in spearheading the bill.

Susannah Engdahl:  Susannah’s principal project this summer involved the development of a compilation of clinical and economic evidence from academic literature to demonstrate the value of O&P care for use in advocacy materials.  Citations to the evidence base are critical in making compelling policy arguments and Susannah’s work product this summer will inform NAAOP’s policy and advocacy efforts well into the future.

CMS Issues DMEPOS Proposed Rule

On July 29, 2019, the Centers for Medicare and Medicaid Services (CMS) released the proposed rule containing updates to the Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) regulations. The full text of the rule can be found here, and a CMS fact sheet summarizing the major provisions in the rule can be found here. Comments on the proposed rule are due September 27, 2019 and can be submitted electronically by following this link or visiting and searching “CMS-1713-P.”

The rule includes a number of provisions that impact orthotics and prosthetics (O&P).  Unfortunately, the rule again applies DME-centric policies to O&P care, thereby increasing the importance of our legislative push to further separate DME from O&P.  The most significant proposals involve a new process for calculating payment amounts for new technologies receiving HCPCS codes (“gap-filling”) which may create a major disincentive for innovators to invest in bringing new O&P technologies to market.  The proposed rule also includes a new consolidated list of DMEPOS eligible for prior authorization.  In addition to the 82 L-codes already eligible for prior authorization, CMS adds 144 new L-codes to the Master List, with little justification.  NAAOP will be working with its Alliance partners to respond forcefully to this proposed rule.

Thank you again for your support of NAAOP and our Fellowship Program.  And thank you to Alicia and Susannah for bringing their skills, enthusiasm, dedication, and personal knowledge of O&P care to Washington, DC.

  • Written by NAAOP

NAAOP Fellows visit OPGA, NCOPE, ABC, and AOPA


By Alicia Carver and Susannah Engdahl

The NAAOP Fellows were on the road again during the week of June 24th. We started with a visit to Iowa, where we met with Todd Eagen, President of OPGA, and Kelly Turner, Member Development Coordinator of OPGA. They taught us how OPGA works to support independent O&P practitioners by providing services relating to insurance, business management and marketing, and by offering access to discounted supplies from manufacturers. We also had a meeting where we learned about advocacy from several Iowa state legislators, including former Iowa State Senator Jeff Danielson, former Iowa House Speaker Christopher Rants, and Iowa State Representative Timi Brown-Powers. It was very helpful to hear their perspectives on how to advocate in a manner that legislators find helpful.

Our next trip was to Virginia, where we were hosted by NCOPE and ABC. Robin Seabrook, Executive Director of NCOPE, shared a presentation about the history of NCOPE and the role that it currently plays in accrediting orthotics and prosthetics education programs, as well as elevating the educational standards for practitioners in training. Afterwards, we learned about ABC from Cathy Carter, Executive Director, and Steve Fletcher, Director of Clinical Resources. They talked with us about the process that must be followed for certifying practitioners and accrediting orthotics and prosthetics facilities, as well as the role that ABC plays in overseeing these processes. We also appreciated learning about the missions of NCOPE and ABC complement each other and ultimately work together to advocate for high quality patient care and professional standards.

We ended our week with AOPA. There we met with Eve Lee, Executive Director of AOPA, and Ashlie White, Director of Strategic Alliances. We sat in on a conference with the whole AOPA team, gained a more in depth knowledge about AOPA and learned how they as a collective team help the orthotic and prosthetic profession. We learned how to utilize the AOPA Co-OP database. It is a wonderful and valuable tool that can help us through our fellowship and beyond as we find our place in the world of advocacy and health policy.

We had a great time during all of our trips and would like to thank everyone who shared their time with us! We felt very welcomed by everyone who hosted us.

  • Written by NAAOP

NAAOP Fellows Visit The Academy, OPIE Software, and Hanger Clinics

By Alicia Carver and Susannah Engdahl, Ph.D.

The week of June 17th was a busy one for the NAAOP Fellows. We began our week with a visit to the American Academy of Orthotists and Prosthetists, where we met the team and attended a weekly staff meeting. We learned about how the Academy compiles educational and research resources, such as the Online Learning Center, the Exam Preparation Seminars, and the Journal of Prosthetics & Orthotics, that allow members to continue learning new ways to meet patient needs. We would especially like to thank Chellie Hollis Blondes, Executive Director, and Manisha Bhaskar, Senior Director of Communications & Marketing, for taking time to share with us their roles in leading the Academy.

Immediately after our visit to the Academy, we hopped on a plane to Florida to see the Gainesville Prosthetics and Orthotics clinic and meet Paul Prusakowski, CPO, FAAOP, and CEO of OPIE Software. We learned about the history of OPIE from Paul and spent the rest of the day talking with other members of the OPIE team about their areas of expertise. In particular, we heard about the software development cycle, customer experiences with implementing the software, the knowledge-centered customer support system used when answering customer questions, and the OPIE Choice Network.

After returning from Florida, we spent two days touring the Hanger Clinic in Laurel, MD and in Washington, DC at the National Rehabilitation Hospital. We had the opportunity to sit in on several patient visits in Laurel, including with a patient who was new to that particular clinic. During this visit, we were able to observe how the prosthetist used patient-reported outcome measures to assess the patient’s current functional status and evaluated the socket fit to determine if a new prosthesis was needed. We also had a conversation with Suzi Vicino, Directory of Utilization Management Services, about successful strategies for submitting clinical documentation for reimbursement.

At the National Rehabilitation Hospital, we learned about the differences in how an O&P clinic operates when embedded in a hospital. After sitting-in on a patient visit and observing how modifications are made to a test socket, we toured the two therapy gyms at the hospital and learned how the prosthetists, orthotists, physical therapists, and occupational therapists strive to coordinate with each other to maximize their patients’ success. We would like to thank Maggie Baumer, an NAAOP board member, for organizing the trip and accompanying us during our entire time at Hanger. She introduced us to so many of her colleagues who shared their experiences.

Thank you to everyone who took the time to meet with us on our trips this past week, and for showing us such warm hospitality! We enjoyed this week very much and appreciate the efforts of everyone who made it possible.

  • Written by NAAOP