AOPA digs in on bill

H.R. 5262 seeks to clarify definition of ‘off the shelf’
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Thursday, February 6, 2020

WASHINGTON – O&P stakeholders are eyeing a pair of possible legislative vehicles as they seek to pass a bill that would improve patient care and reduce fraud.

The American Orthotic and Prosthetic Association has been working with lawmakers to fit their bill into either drug pricing legislation or the Cures 2.0 initiative, says Justin Beland, director of government relations.

“We’re confident that one of those two vehicles will give our bill a ride,” he said.

H.R. 5262, the Medicare Orthotics and Prosthetics Patient-Centered Care Act, introduced in November by Rep. Mike Thompson, D-Calif., seeks to, among other things, clarify the definition of “off-the-shelf” orthotics to mean those that require minimal self-adjustment by patients themselves, and prohibit drop-shipping of orthotic braces that do not meet the bill’s definition of “off the shelf.”

A lot hangs on the definition of “off the shelf”: CMS has expanded the definition to include orthotics adjusted by the supplier or caregiver, and it has included certain back and knee braces in Round 2021 of competitive bidding.

“If you look at some of the orthotics that have come out over the last few years it’s clear people would not be able to adjust themselves,” he said. “CMS including these under the self-adjusting definition has created problems—people are wearing orthotics wrong, cutting off nerves.”

The bill also seeks to distinguish O&P from the DME benefit, making the case that orthotics require specialized training and are clinical in nature, and are not commodities, says Beland.

“Our practitioners are seen as suppliers of DME and not medical practitioners,” he said. “Distinguishing statutorily from DME is the first domino we hope to have fall for a long-term process to change the whole way we look at the O&P profession.”

AOPA has already initiated a few calls to action, resulting in 1,200 calls and emails to lawmakers in support of the bill, and is close to getting a lead sponsor for a Senate companion bill.

While efforts to improve the O&P benefit and combat fraud, waste and abuse have been ongoing for several years, headlines last year related to a massive $1.2 billion fraud takedown known as Operation Brace Yourself mean lawmakers are now more aware of the need for change, says Beland.

“It gives us a good talking point on Capitol Hill,” he said.