July was an exceptionally busy month for NAAOP and our 2024 Breece Fellow, Taylor Haines, who has now completed her fellowship. The hard work is paying off, with significant advancement across several policy areas.
MKP Coverage Expansion: This biggest victory this month for both NAAOP and its O&P Alliance partners was publication by the Centers for Medicare and Medicaid Services (“CMS”) and the Durable Medical Equipment Medicare Administrative Contractor (“DME MAC”) Medical Directors of the much-anticipated final Local Coverage Determination (“LCD”) L33787 Lower Limb Prostheses. The final LCD expands the coverage criteria for microprocessor-controlled prosthetic knees (“MPKs”)—including fluid and pneumatic knees—for Medicare Functional Classification Level (“MFCL”) 2 beneficiaries, individuals with lower limb loss who are considered limited community ambulators and require a prosthetic knee based on the best available evidence. They also published an updated Policy Article that offers additional details on this new coverage policy and posted a response to the comments they received from O&P stakeholders on their respective websites. The effective date for this final LCD is September 1, 2024.
Virtual Congressional Fly-In: NAAOP held its annual Virtual Congressional Fly-In on July 16th to promote the Medicare O&P Patient-Centered Care Act, H.R. 4315 and S. 3977. This bipartisan bill would reduce fraud and abuse while improving patient care and making orthotic treatment more accessible to Medicare beneficiaries. NAAOP members and former Breece Fellows participated in over 35 meetings with Congressional staff and Members of Congress to seek movement on this important legislation. Taylor Haines, an Oregon resident, participated in a meeting with Senator Ron Wyden’s health policy staff and made a strong connection to that office. Along with an AOPA representative, NAAOP, including Taylor, then attended a breakfast meeting with Senator Wyden, Chairman of the Finance Committee, the committee with jurisdiction over the bill. Taylor and Chairman Wyden bonded as fellow Oregonians during this meeting, prompting another meeting the following day with Senate Finance Committee staff. Once again, NAAOP and AOPA collaborated in this meeting which provided some hope for greater attention to the legislation in the months to come.
Webinar on Medicare Coverage Improvements: NAAOP also hosted a webinar on July 23, 2024 that attracted a sell-out audience. The webinar focused on the newly-released MPK coverage policy for K-2 beneficiaries with limb loss and detailed the documentation and medical necessity requirements for coverage. But the webinar also delved into other advances in O&P coverage and coding over the past two years. The webinar included topics such as designation under the orthotic benefit category of powered orthoses, which signals coverage of a whole new family of orthoses; coding and payment of a bone-anchored device that advances coverage of osseointegrated prostheses; coding changes to the upper limb prosthetic benefit that will likely lead to improvements in coverage of partial hand and finger prostheses. Finally, the webinar mentioned the announcement in May 2023 of a National Coverage Determination on seat elevation in power wheelchairs, benefitting individuals with limb loss who may require use of wheeled mobility in their homes.
For More Information: Access the Webinar Presentation on Expanded Medicare Coverage dated July 23, 2024.
Thank you to our members and please consider joining NAAOP to support our important policy and advocacy work for the O&P profession and the patients we serve.
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