Significant developments occurred over the past several weeks impacting the orthotics and prosthetics community including the following:
Introduction of Senate Bill 4503: Senators Daines (R-MT), Warner (D-VA), Cassidy (R-LA), Duckworth (D-IL), and Cornyn (R-TX) and introduced S. 4503, a companion bill to H.R. 5262, the Medicare O&P Patient-Centered Care Act of 2020. This long-awaited legislation is bipartisan, mirrors the House version of the bill, and provides the O&P community with a legislative goal in the Senate. S. 4503 separates DME from O&P clinical services, reinstates Congressional intent on the meaning of off-the-shelf (OTS) orthotics for purposes of competitive bidding, exempts certified and licensed orthotists and prosthetists from OTS competitive bidding, and prohibits “drop shipping” to patients homes of any orthoses or prostheses that require clinical services. NAAOP supports this legislation and encourages our members and friends to write your Senators seeking cosponsorship of the bill by clicking on https://naaop.org/congressional-action-center/.
S. 4343; The Triple A Study Act: The Amputee Coalition of America recently announced introduction of the Triple A Study Act, bipartisan legislation sponsored by Senators Blackburn (R-TN) and Duckworth (D-IL) that would collect nationwide data on limb loss and limb difference and update our collective knowledge base of the patients served by the O&P profession. NAAOP supports this legislation and will be advocating for its passage.
Medicare Audits and Prior Authorization: Having suspended Medicare audits and implementation of prior authorization for six lower limb prosthetic codes due to COVID-19, CMS has now reengaged these programs. As of August 3, 2020, Medicare contractors are permitted to begin audits of Medicare providers and suppliers but have been instructed by CMS to accommodate those providers overwhelmed by COVID response. CMS is also pursuing prior authorization of six lower limb prosthetic codes beginning September 1st in four states (i.e., TX, CA, MI, and PA) and will implement the program nationally on December 1st. In addition, lower limb prosthetic components described by these six codes must be verified by the PDAC by January 1st. For more information on the prior authorization program, Noridian will be hosting a webinar on September 10th at 12:00 Noon, Central Time. Click here to sign up for this webinar.
OIG Orthotics Reports Continue to Alarm the O&P Community: In the past several weeks, three separate HHS Office of Inspector General (OIG) reports have been issued on suppliers of orthotics, asserting very high error rates, in some instances 100% of the claims reviewed. The suppliers under review typically employ a business model reliant upon drop shipping certain typically off-the-shelf orthoses directly to patients’ homes. The OIG asserts that a simple physician prescription is not enough to justify medical necessity and that suppliers are obligated to verify the medical necessity of the orthoses they bill to the Medicare program. These reports reflect negatively upon the orthotics community, but they also provide evidence of the need for Congress to pass the Medicare O&P Patient-Centered Care Act and are helpful in making that case to legislators.
Nicole Ver Kuilen Just Felt Live Running: Nicole Ver Kuilen, the NAAOP Inaugural Fellow and one of our newest NAAOP board members, announced on July 20th, in conjunction with the 30th Anniversary of the Americans with Disabilities Act, a virtual race to be held on October 3rd across the country to promote exercise among people with disabilities. The race is being organized by Nicole’s organization, Forest Stump, and is designed to highlight the discriminatory effect of coverage denials by insurance companies of prosthetics, orthotics, and assistive devices and technologies that allow people with disabilities to be physically fit and active. The virtual race will culminate in Washington, D.C. with the delivery to Congress of a petition to make this point. To support this incredible effort, please click on the following link. www.ForrestStump.org/Take-Action Congratulations Nicole on this innovative advocacy project! NAAOP is with you all the way!