2/28/2008
O&P Issues in the 2nd session of the 110th Congress
NAAOP Continues to Press Case on Veterans and Medicare Issues
February 2008
Members of Congress returned in mid-January to begin the second session of the 110th Congress and quickly began discussions on major policy issues, including Medicare physician and provider payments. The VA Committees also intend to consider legislation in the near future to implement some of the recommendations of the President’s Commission on Wounded Warriors, presenting NAAOP with an opportunity to convince the House and Senate to establish a "Bill of Rights" for injured veterans in need of orthotic and prosthetic care. The first several months of 2008 are expected to produce a flurry of Congressional activity on VA, Department of Defense, Medicare, and budget issues, but whether that activity will lead to substantial policy changes remain unclear in a very partisan and volatile Presidential election year.
Scheduled cuts to Medicare physician payments forced an end-of-the-year negotiation on a Medicare package that failed to attract enough votes to pass. In the ashes of a broken deal, Congress simply pushed major action off until 2008 by passing a six-month Medicare "fix" to the physician fee schedule that expires on June 30 of this year. This means that Congress is already considering ways to pass a more substantive and long-lasting Medicare package and will have to act on some type of legislative package by July 1st if they intend to stave off a 10% cut in physician's fees for the remainder of the calendar year. The short-term Medicare bill passed in December included no cuts to the O&P fee schedule and, therefore, the O&P field received a full CPI update on January 1st worth approximately 2.7% over current fees. NAAOP is currently working with Congress and in concert with the O&P Alliance to maintain this CPI increase through the second half of 2008.
Meanwhile, President Bush is urging Congress to reign-in Medicare spending. The President recently released his last federal budget proposal for fiscal year (FY) 2009, and proposes to cut over $180 billion over five years from the program, largely through freezes to a whole host of health care providers. The budget does not contain sufficient detail to assess whether the O&P fee schedule would suffer the same fate as virtually all other providers under the Medicare program, but there is nothing to suggest that the annual update is preserved for the O&P fee schedule under the proposal. This proposed Bush budget does not appear to have gained much traction since it was announced in early February, but Congress is currently operating under pay-as-you-go (PAYGO) rules and lawmakers must include ways to pay for the physician fee fix in any bill they pass. These "pay-fors" will likely come from cuts to other providers, and O&P may be in the crosshairs, as many other provider groups will be as well.
CMS is also active on the Medicare regulatory front on O&P issues. In the past several weeks, CMS has issued new proposed Medicare supplier standards that tighten up who can become Medicare "suppliers" of DMEPOS items and services. They have also issued new revisions to the Medicare quality standards that all suppliers must meet, including a significantly redrafted section that applies to orthotic and prosthetic care. While these proposed standards continue to fall short when it comes to which type of suppliers are qualified to provide various levels of complexity of O&P care, the new quality standards are a significant improvement over the original version. NAAOP will be submitting comments, along with the O&P Alliance, on these important regulatory priorities.
As for injured veterans, NAAOP has developed a close working relationship with the Veterans Affairs committee in the House and Senate and is advocating for the establishment of a veterans O&P "Bill of Rights." NAAOP also recently met with senior officials at the VA's Prosthetic and Sensory Aids Service to try to resolve problems that have arisen in Southern California and in other areas of the country, including the problem of the VA bringing most O&P services in-house. Finally, NAAOP recently met with the Department of Defense to discuss continuity of care issues as service men and women with musculoskeletal injuries transition to the VA from the DOD health program.
The upcoming Presidential and Congressional elections will have a significant impact on the outcome of this year's Medicare debate as well as health care reform well into the future.
NAAOP will continue to closely monitor the status of Medicare legislation will continue to advocate to protect the O&P fee schedule, as well as improve the link between quality of care and qualifications of suppliers as a Medicare bill moves forward. NAAOP will also press forward with efforts to maximize access and quality of O&P care provided to injured veterans.
Prepared by Peter W. Thomas, General Counsel, NAAOP, and
Emily Niederman, Legislative Director, Powers Pyles Sutter & Verville, PC.
