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Major Legislative Developments Impact O&P Care

Two major legislative efforts impacted orthotics and prosthetics in July as the House adjourned for their August recess and the Senate delayed their break to proceed to critical votes on other matters.

  1. ACA Repeal and Replace: The Senate debated whether to repeal and replace the Affordable Care Act at length and voted on several different versions of the bill.  Other than the “motion to proceed” with debate on the overall subject (which passed 51 to 50), all amendments were not able to attain the fifty votes needed for Vice President Pence to break the tie vote.  With all Democrats and Independents firmly against repeal and replace, Majority Leader McConnell (R-KY) could not lose more than two of the 52 Republican votes.  In the end, Senators Collins (R-ME), Murkowski (R-AK) and McCain (R-AZ) prevented the bill from proceeding and the Majority Leader was forced to pull the bill from consideration at 1:40 a.m., Friday, July 28th.  The main reason cited by these senators was the expected impact of coverage losses in their states.  This is a major development considering the long-standing call to repeal the ACA, but the effort to reform American health care will no doubt continue given the fragile condition of the private insurance market and the ever-growing federal investment in the Medicare and Medicaid programs.From an O&P perspective, failure of a repeal and replace effort temporarily removes a threat to O&P access and coverage across the private insurance market and Medicaid expansion programs.  There may be additional legislative efforts later this year as well as efforts that do not require legislative action.  For instance, the Secretary of Health and Human Services has significant authority to redesign regulations that impact the essential benefit package and the category of benefits known as “rehabilitative and habilitative services and devices.”  NAAOP expects proposed regulations in the near future that will give states much more flexibility in designing essential benefits, and O&P benefits are likely to be among the benefits that are limited or restricted in certain ways.  NAAOP will continue monitoring this situation closely to ensure maximum coverage of O&P care for the benefit of patients and their providers.

  2. Recognition of Clinical Notes of the O&P Practitioner: On July 25th, the House of Representatives passed bipartisan Medicare legislation, H.R. 3178, to recognize that “documentation created by an orthotist or prosthetist shall be considered part of the individual’s medical record to support documentation created by eligible professionals…”   This declaration will be tremendously useful in demonstrating medical necessity when Medicare contractors determine whether to deny O&P claims.  NAAOP recognizes and thanks AOPA for its extensive efforts on this achievement as well as the House sponsors including Glenn Thompson (R-PA), Mike Bishop (R-MI) and Mike Thompson (D-CA).  The bill now proceeds to the Senate where Senators Grassley (R-IA), and Warner (D-VA) have introduced the Medicare O&P Improvements Act, S. 1191, bipartisan legislation that includes this provision, as well as a number of other critical policy changes that benefit O&P.

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