NAAOP Welcomes Kate Ketelhohn, 2023 Breece Fellow New Rules Help O&P Providers Challenge Medicare Advantage Denials
The 2023 NAAOP Breece Fellow, Kate Ketelhohn, began her fellowship program in Washington, DC, to learn more about O&P policy and advocacy. Kate, a rising Junior at Johns Hopkins University where she is on a pre-med track, has used three orthoses and prostheses since her early childhood. Kate is shadowing NAAOP General Counsel, Peter Thomas, and learning about O&P policy and advocacy in the context of broader rehabilitation and disability issues. She is researching veterans policy, osseointegration, and will help orchestrate an NAAOP Virtual Fly-In this July to help build support for the Medicare O&P Patient-Centered Care Act. She will also help organize and present an important webinar on new rules that will help O&P practitioners challenge denials of Medicare Advantage (MA) claims. New MA Rules On April 12, 2023, the Centers for Medicare and Medicaid Services (CMS) published the Contract Year 2024 Policy and Technical Changes to the Medicare Advantage and Medicare Prescription Drug Benefit Programs Final Rule revising provisions of the Medicare Advantage (MA) program. This Final Rule includes substantial changes to MA including instituting guardrails around the use of prior authorization. The final rule became effective on June 5, 2023 although the policies will be implemented in the new contract year starting on January 1, 2024. NAAOP and several other O&P organizations strongly supported the proposed rule in written comments submitted earlier this year. For the first time, the Final Rule implements several policies that will make it easier for O&P practitioners to challenge denials of MA claims for prosthetic and orthotic care. For instance, the new rules require MA plans to abide by fee-for- service or “Traditional” Medicare coverage rules, limit the use of internal MA or third party proprietary coverage guidelines, guarantee a 90-day prior authorization transition period for a beneficiary switching plans, and limit prior authorization as a utilization management tool. They also require that reviewers of MA claims possess training and experience in the medical field in which the claim is being considered. Save the Date! NAAOP will host a webinar on these new MA rules on July 27, 2023 at 1:00 p.m., Eastern Time. Look for an invitation in the near future from NAAOP. The webinar will be free of charge and will be designed to give O&P practitioners the tools they need to challenge denials of O&P care from Medicare Advantage health plans.