As the 116th Congress gets off to a slow start, the President’s plans for health care policy will begin to emerge over the coming weeks. First, the President will deliver his delayed State of the Union address which will include goals involving HIV/AIDS and perhaps other health care priorities. Next, we will see the President’s FY 2020 federal budget proposals which will be released late due to the impact of the federal shutdown. Once these proposals are made public, NAAOP will report on their potential impact on access to O&P care.
In the meantime, NAAOP is working with AOPA and members of the O&P Alliance on the path forward on off-the-shelf (OTS) orthotics and other priorities in the Medicare O&P Improvement Act. Last year witnessed the enactment of the provision recognizing the value of the O&P practitioners’ clinical notes as part of the patient’s medical record for determining medical necessity. This was a significant victory with many positive implications.
Extensive efforts were also expended to pass a provision redefining and limiting the scope of OTS orthotics subject to possible competitive bidding in the future, but this legislation did not make it across the finish line before the 115th Congress adjourned. Late in the session, the Congressional Budget Office surprised everyone by claiming that the cost of the bill would have to be offset by a 35% reimbursement cut to over 50 orthotic codes, which was a non-starter. The bill was actually pulled from House floor consideration hours before it was scheduled for a vote.
We are now in the process of working collectively to plot a legislative strategy for the 116th Congress. We intend to reframe the O&P Medicare Improvement Act to focus on patient protection. We intend to streamline the bill, focus on those provisions that developed traction in the previous Congress, and eliminate the most complex aspects of last year’s bill. We are also discussing new provisions that will recast the bill in a manner that we hope will engender positive attention from Congress and the Administration.
This is particularly important now that CMS has announced its intention to subject 24 knee and back orthoses to competitive bidding in the next round of that program. NAAOP and the O&P Alliance believes that 22 out of the 24 codes at issue are custom fit orthoses, not off-the-shelf, and are, therefore, pushing back hard against this proposal.
NAAOP will continue working with its O&P allies to advance policies that benefit patients and the providers who serve them.