Lawmakers weigh in on O&P

‘Get this done,’ agrees AOPA
Friday, May 29, 2015

WASHINGTON – Lawmakers recently sent a letter to CMS demanding the agency enforce long-established O&P licensure and certification requirements.

The May 19 letter to Department of Health and Human Services Secretary Sylvia Burwell asks CMS to issue a proposed rule detailing its plans to allow only licensed and certified O&P providers to bill Medicare, as required by a law passed back in 2000.

“It’s been 15 years without anything being done,” said Tom Fise, executive director of the American Orthotics and Prosthetics Association. “We wanted to put an exclamation point on the need to get this done.”

The letter, signed by 26 representatives, also seeks to have CMS revise its definition of “minimal self-adjustment” for off-the-shelf orthotics to mean adjustments made by the patient only—not a caregiver or supplier; and modify its list of OTS codes to ensure that it does not include any device that does not meet that definition. 

Lawmakers also introduced a pair of bills in March that seek to, among other things, apply accreditation and licensure requirements to O&P providers who bill Medicare. 

On May 1, AOPA briefed members of Congress on the latest in prosthetic technology, insurance challenges for patients, and legislative and regulatory issues. The briefing, which included representatives from Ottobock USA and a survivor of the Boston Marathon bombing, was held as part of AOPA’s “Mobility Saves” campaign.

“We have put a lot of energy into spreading the message that if you provide timely and appropriate care to these patients, it costs payers less then if they don’t get that care,” said Fise. “We had not systematically put that all together.”