Election Results Set Stage for Health Care Policy Changes
2020 Election: President-Elect Biden’s win in the 2020 election was muted by weeks of controversy over vote counts and legal challenges but the transition to a Biden Administration is now underway. The expected “blue wave” did not materialize as some expected, with Democrats losing several seats in the House, making the 117th Congress one of the slimmest Democratic margins in recent memory. Senate Republicans lost one seat and retain control of that chamber to date, but two runoff elections scheduled for January 5th in Georgia will determine whether Republicans or Democrats control the Senate. If Democrats win both seats, an unlikely prospect, Democrats will be able to pass budget legislation with a simple 51-vote majority, but most legislation will still require bipartisan cooperation to prevent a 60-vote Senate filibuster. Either way, the mixed results place tremendous emphasis on the need for bipartisan cooperation.
Prior Authorization: Prior authorization of six lower limb prosthetic HCPCS codes will be implemented nationwide on December 1, 2020 as the four-state pilot program, which began September 1st, is expanded. By all accounts, the program has been more successful than expected, with relatively quick prior authorization approval times. The upside of prior authorization is that claims for payment are afforded some degree of finality, with less risk that such claims will be audited by Medicare contractors and the funds recouped. If you experience problems with the nationwide rollout of prior authorization, please report your experiences to NAAOP and ask your patients to call 1-800-Medicare to lodge a complaint with the program.
OTS Competitive Bidding: The Medicare program is pressing forward with implementation of competitive bidding of certain off-the-shelf (“OTS”) orthotics in 127 competitive bidding areas (“CBAs”) throughout the United States on January 1, 2021. Despite requests to delay the program due to the pandemic and the lack of sufficient notice to providers, CMS is rolling out the program which applies to 23 HCPCS codes for OTS knee and back braces. The program was able to achieve, on average, 30% to 35% reductions in reimbursement amounts, varying by geography. According to Medicare data, certified and/or licensed orthotists provide less than 20% of these orthoses, with physicians, therapists, DME suppliers and pharmacies providing the bulk of these orthoses. Claims submitted for these 23 OTS codes will not be paid if the supplier does not have a competitive bidding contract.
NAAOP Virtual Congressional Fly-In: NAAOP is hosting a “pilot” virtual Congressional Fly-In to promote passage of O&P legislation including the Medicare O&P Patient-Centered Care Act (S.4503) and the Triple A Study Act (S. 4343). The Fly-In is a pilot to test the effectiveness of a virtual model as Congressional members and staff adapt to advocacy during a pandemic. Over 20 board members, NAAOP Fellows, and key NAAOP members will participate in over 50 telephonic meetings on December 8, 2020. NAAOP will assess the effectiveness of this model and decide whether to host these fly-ins in the future.
Thanksgiving: It has been a very difficult year by all accounts, but NAAOP is optimistic that better days lie ahead. We at NAAOP take this opportunity to wish all NAAOP members and friends a Happy Thanksgiving in the safest and most meaningful way possible. And, as always, we thank you for your membership and support!