National Legislation and Regulation/Quality and Qualifications
CMS Issues Scaled Back Quality Standards: A Double-Edge Sword
The month of August finally brought the publication by CMS of the final quality standards and accreditation requirements on DMEPOS suppliers, enacted as part of the Medicare Modernization Act of 2003. All DMEPOS suppliers will eventually be required to become accredited and demonstrate compliance with the quality standards, but the first suppliers to be exposed to these requirements will be those suppliers who participate in competitive bidding in ten yet-to-be selected U.S. cities.
As detailed and lengthy as the proposed quality standards were (100 pages) when issued in the Fall of 2005, the final quality standards are general and far less onerous (14 pages). While this is good news for O&P providers in terms of not needing to demonstrate compliance with a raft of new Medicare requirements, it is clearly a double-edge sword. Because the O&P field long ago embraced accreditation of facilities and certification of practitioners while the DME field did not, the final quality standards may prove to actually “lower the bar” of quality O&P care over the long term.
In addition to the MMA requirements, the Beneficiary Improvement and Protection Act of 2001 (BIPA) established qualification standards for suppliers of certain orthotic and prosthetic services and devices. While the quality standards and accreditation requirements have been issued by CMS this month, the BIPA regulations have still not been released.
NAAOP strongly supports the imposition of strong accreditation requirements on DMEPOS suppliers, the establishment of effective quality standards to ensure that Medicare beneficiaries receive high quality orthotic and prosthetic care, and qualification standards on suppliers to ensure that Medicare only reimburses orthotic and prosthetic suppliers who possess the requisite education, training, and experience to provide high quality care.
NAAOP, along with the other organizations that comprise the Orthotic & Prosthetic Alliance, is concerned that if CMS only requires that an accrediting agency ensure that a DMEPOS supplier meets the very general and basic quality standards published by CMS, multiple agencies will design bare-bones accreditation programs for suppliers who wish to have access to the O&P billing codes (i.e., L-codes). This could have the effect of enabling a significant number of suppliers who have limited or no knowledge of comprehensive orthotic and prosthetic care to be able to bill Medicare for these services and devices. This, in turn, could lessen the quality of orthotic and prosthetic care and permit far greater numbers than currently exist to provide such services with only minimal education, training, and experience in the specialized field of orthotics and prosthetics.
This, of course, is exactly the opposite result of what was intended by Congress when it passed the MMA and BIPA laws. While it is too early to tell whether this will be the inevitable result, it is possible that the quality standards as written will actually increase utilization of the Medicare L-codes by suppliers who have little of no education and training in comprehensive O&P patient care.
It is for this reason that NAAOP is actively engaged on this issue, along with its O&P Alliance partners, to ensure that Congress’ intent in passing these two laws is implemented correctly by CMS.
NAAOP will continue to keep you informed of developments through our monthly updates and whenever developments dictate that we communicate with our members and the broader O&P field.
Thank you for your Support of our Mission
As a NAAOP member, you are working hard to improve the lives of patients who use orthotic and prosthetic services. In thanks, we would like to reaffirm our commitment to always putting the patient first. We are able to put the patient first only because you support this mission. NAAOP’s mission has always been member driven and people have always come before profits. NAAOP’s voice is respected, trusted, and effective because of this fact. As your leadership, it is an honor and privilege to represent O&P professionals who promote this position and we want to assure you that our commitment to the patient will not waiver.
NAAOP will be exhibiting at the 2006 AOPA National Assembly in Hollywood Florida, September 26 – September 30. We would like to take this opportunity to invite you and your colleagues to visit our booth # 011, which will be located outside the main exhibit hall with the non-profit organizations. It is very important that NAAOP continues to grow and we need your help to accomplish this. The power of your endorsement was demonstrated at the Academy show this past March.
As you know, almost 100% of your membership dollars go to a patient-focused education and advocacy agenda. This is unique in our profession. Our story on video illustrates NAAOP’s unique role and defines our purpose. Ours is a history of dedicated professionals banding together to ensure that individuals who use orthotic and prosthetic services receive the professional care they deserve.
It is important to NAAOP’s future that all those involved in O&P patient care are aware of the important role they can play in this mission. Please share this message and NAAOP’s video with a colleague. Also, please come by our booth and bring a colleague. Invite them to join usin advocating for better evidence, better education of practitioners, greater and better technology for the O&P consumer, and greater access to care.Mark DeHarde PresidentGeorge W. Breece Executive DirectorPeter W. Thomas General Counsel
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