4/6/2007
Final Medicare Competitive Bidding Regulations Spare O&P
NAAOP has spent the past few days analyzing the new 400-page Medicare DMEPOS competitive bidding regulation announced earlier this week and scheduled to be formally published in the Federal Register on April 10th. Other than one lingering issue that involves the definition of "off-the-shelf" orthotics, the final competitive bidding rule largely spares the entire O&P profession from competitive bidding, at least for the next several years. Specifically, all prosthetics and all orthotics except "off-the-shelf" orthotics were statutorily exempted from competitive bidding when the Medicare Modernization Act was passed in 2003. This victory came as a result of concerted efforts by NAAOP and sister associations in the O&P field. But off-the-shelf orthotics were included as long as the government could demonstrate that they would be able to achieve sufficient savings by competitively bidding these orthoses.
In the final rule, CMS essentially concedes that it cannot save enough Medicare dollars by competitively bidding off-the-shelf orthotics to make it worthwhile, and so, they have stated that these orthoses will not be included in the first round of bidding, scheduled to take effect in 10 of the largest U.S. cities over the course of the next year. Whether these orthoses are included in future rounds of competitive bidding (for instance, when CMS expands competitive bidding to 80 additional cities in subsequent years) is not known at this time, but the fact that orthotics and prosthetics were completely omitted from competitive bidding in the first round bodes well for the O&P field.
There is one potential problem with the final rule that involves the definition of off-the-shelf orthoses. The statute defines off-the-shelf orthotics as orthoses that require minimal self-adjustment. In these final regulations, CMS has further defined "minimal self-adjustment" to mean "an adjustment that the beneficiary, caretaker for the beneficiary, or supplier of the device can perform and does not require the services of a certified orthotist (that is, an individual certified by either the American Board for Certification in Orthotics and Prosthetics, Inc., or the Board for Orthotist/Prothetist Certification) or an individual who has specialized training." While this appropriately recognizes the importance of ABC/BOC certification for the provision of more complex O&P care, it also potentially expands the range of orthoses that may be considered "off-the-shelf" in the future. NAAOP intends to work with the O&P Alliance to press CMS to further refine this definition.
The O&P Alliance, of which NAAOP is a member along with AAOP, AOPA, and ABC, has issued a detailed analysis of the final competitive bidding rule in order to educate the O&P profession as to the impact of these new regulations. However, it is important to note that the requirement for ALL DMEPOS suppliers, including those providing orthotics and prosthetics, to become accredited and meet CMS' quality standards remains in effect and will eventually be enforced in the coming years. The accreditation requirement continues to apply to all DMEPOS suppliers regardless of whether they participate in competitive bidding.
The detailed analysis of the final competitive bidding rule is available on NAAOP's website.
