O&P pushes again for separate status

WASHINGTON - The COVID-19 pandemic has shed new light on the ways in which grouping orthotists and prosthetists with other DME suppliers “handcuffs” them as medical practitioners, say stakeholders.

“Every other medical profession is doing more telehealth, including OTs and PTs, and (being considered a supplier) is handcuffing us on being able to bill for telehealth,” said Justin Beland, director of government relations for the American Orthotic and Prosthetic Association.“I think Congress has been surprised—that has resonated on Capitol Hill during the pandemic.”

Distinguishing O&P from other DME is a key provision of The Medicare Orthotics and Prosthetics Patient-Centered Care Act (S. 4503), introduced Aug. 6 by Sens. Mark R. Warner, D-Va., Steve Daines, R-Mont., Tammy Duckworth, D-Ill., John Cornyn, R-Texas, and Bill Cassidy, R-La. It would create separate statutory requirements for the provision of orthoses and prostheses.

The bill also seeks to:restore the term “minimal self-adjustment” to more clearly define off-the-shelf orthoses; and prohibit the practice of “drop shipping” custom orthoses and prostheses, as well as off-the-shelf orthoses.

A previous version of the bill was championed by Sen. Chuck Grassley, R-Iowa, who chairs the powerful Senate Finance Committee, and Beland is optimistic about S. 4503's chances this year. The bill, which is a companion bill to H.R. 5262, introduced in November, could get attached to a larger vehicle, such as the Medicare extenders package that will have to be passed before the end of the year.

“Knowing that Grassley has been so passionate in the past—we know Grassley wants this,” he said. “Now, we really are getting the message out on Hill.”

While AOPA wants people to be able to order braces online, the association also wants to make sure those devices are truly off-the-shelf, says Beland.

“People are getting devices that they have virtually no idea how to use, but there are also these lead generators calling up Medicare beneficiaries, sending them orthotics they don't need,” he said.