9/4/2008
Congress and CMS Carve Huge Exemption for DME from Accreditation Requirements and Quality Standards: New Regulations for O&P to be Proposed
NAAOP Government Relations Update:
Congress and CMS Carve Huge Exemption for DME from Accreditation Requirements and Quality Standards: New Regulations for O&P to be Proposed
Congress passed a Medicare bill in July by overriding a Presidential veto, granting physicians a fee schedule update rather than a 10% cut in fees. The bill also contained another provision pushed by physicians, a grant of authority to the Secretary of Health and Human Services to exempt them and other "professionals" from the accreditation requirements and quality standards established for Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS). CMS was given discretion to exempt these “professionals” if CMS determined that the accreditation requirements and quality standards were not specifically designed with them in mind. In other words, if CMS determined that the standards were primarily designed for DME and other suppliers, rather than physicians, they could be exempt.
Since the passage of this summer’s Medicare bill, numerous stories in major newspapers have highlighted the problem of fraud and abuse in the DMEPOS benefit. CMS was recently embarrassed by revelations that they grossly underestimated and under-reported to Congress the amount of fraud and abuse occurring in the Medicare program. The accreditation requirements and quality standards were intended to reduce fraud and abuse and improve the quality of care.
However, on September 3rd, CMS held an Open Door Forum by teleconference and announced that they essentially abandoned their discretion to make individual interpretations for each type of professional. Instead, CMS imposed a blanket exemption from the DMEPOS accreditation requirements and quality standards for all physicians as well as a whole host of other professionals, including therapists, but also including orthotists, prosthetists, and pedorthists. This means that the quality standards described in Appendix C that apply to the provision of orthotics, prosthetics, and pedorthics will not apply to these practitioners going forward. This also means that the DMEPOS quality standard and accreditation requirements, including Appendix C, will primarily apply to DME suppliers, pharmacies, and similar suppliers.
CMS made great efforts to state that they are currently undergoing "rulemaking" to implement new provider qualification requirements for those who provide orthotic and prosthetic care, pursuant to the Benefits Improvement and Protection Act (BIPA) of 2001, a law that was never implemented. CMS expects to propose these new regulations in the first half of 2009, but with the change in Administration, this timeline is subject to question. During the CMS conference call, CMS repeatedly acknowledged the arguments made by the O&P field and warned participants in the call that more O&P regulations are yet to be announced, but, unfortunately, CMS's track record in establishing meaningful consumer protections for O&P patients has not been impressive to date.
NAAOP will continue to make the O&P case with CMS and Congress and to work in concert with the other O&P organizations to establish, once and for all, appropriate quality standards and accreditation requirements for all providers and suppliers of O&P care.
