Veterans Choice of O&P Practitioner

Submit Comments by December 15th to Help Preserve Veterans’ Right to Choose

NAAOP asks its members and friends to take action by December 15th by submitting comments opposing the proposed Veterans Administration regulation to eliminate amputee veterans’ choice in selecting a VA prosthetist/orthotist or a private, VA-contracted prosthetist/orthotist, to provide their O&P care.  As currently drafted, the VA’s proposed rule found at this link (https://www.federalregister.gov/documents/2017/10/16/2017-22358/prosthetic-and-rehabilitative-items-and-services) could seriously erode veterans’ access to appropriate, timely and convenient O&P care.

For over fifty years, the VA has contracted with private practitioners to provide timely and quality O&P care to veterans with limb loss and other disabilities who honorably served our country.  These contractual arrangements offer veterans with amputations greater access to high-quality professionals, the newest technologies, and state-of-the-art laboratories where prostheses and orthoses are designed, fit and fabricated.  For years, private, VA-authorized O&P practitioners have played a vital role in augmenting the VA’s capacity to serve our nation’s veteran amputees and others with disabling conditions.

On October 16, 2017, the VA issued a proposed rule that would reverse this long-standing VA practice by insisting that the VA has the sole authority to determine whether a veteran can access a private O&P practitioner with a VA contract.  The proposed rule states that this is an “administrative business decision” without any reference to the importance of clinical circumstances of the patient.

This proposal would effectively deny veterans their right to select a prosthetist/orthotist of their choice, an important quality indicator and patient protection that has long been VA policy.  This proposal is striking because it runs counter to the key tenets of the Veterans CHOICE Program, which allows veterans to access VA-funded health care services in the private sector.

ACTION ALERT:  Please take action by December 15th by submitting comments to the VA opposing this proposed change in policy and asking the VA to maintain veterans’ right to choose their O&P practitioner, whether that practitioner is a VA employee or a private O&P practitioner with a VA contract.  Here is how you can help and thank you for your efforts:

  1. Click here to access a draft letter for practitioners to use in submitting comments.
  2. Click here to access a draft letter for your veteran patients to use in submitting comments.
  3. Modify the letter(s) to suit your own situation and add any additional comments you wish. Ask your veteran patients to participate.
  4. Go to this link, https://www.regulations.gov/comment?D=VA-2017-VHA-0023-0003 to electronically submit your comments. You have two options:
    1. Write “See attached letter” in the comment window and follow directions to upload your letter in PDF format; or,
    2. Copy and paste the contents of your letter into the comment window and hit send.
  • Written by NAAOP

VA Choice of Practitioner and Medicare Competitive Bidding

Two major issues are heating up in Washington, veterans’ right to choose their O&P practitioner and Medicare competitive bidding of an expanded range of durable medical equipment, prosthetics, orthotics and supplies (DMEPOS).

VA Choice of Practitioner

The VA published a proposed rule in October making the VA the “sole” authority in choosing the O&P practitioner who will provide services to each veteran.  By doing so, VA proposes to fundamentally change the right that veterans have had for five decades to choose the O&P practitioner who best meets their needs, whether that practitioner is a VA employee or a private provider with a VA.  NAAOP strongly opposes this proposed change and will be working with its O&P Alliance partners to maintain veteran choice.

This “right” is included in the Injured and Amputee Veterans Bill of Rights (H.R. 2322), bipartisan legislation introduced by Congressman Tim Walberg (R-MI).  NAAOP is working with Cong. Walberg to advance the bill or, in the alternative, to try to impact the pending VA CHOICE 2.0 legislation.  This bill would make permanent the VA CHOICE program enacted several years ago.  The bill would expand veterans’ choice of private health care providers, exactly the opposite direction than the VA’s proposed rule on prosthetics.  Look for more information as to how NAAOP members can help on these issues in the coming days.

Expanding Medicare Competitive Bidding

On November 2, the Medicare Payment Advisory Commission (MedPAC) hosted a meeting entitled:  Medicare payment policy for non-competitively bid DMEPOS.  MedPAC staff opened the session by presenting the slide deck accessed here. MedPAC reviewed spending trends and pricing accuracy of non-competitively bid DMEPOS.  Staff indicated that across its top 25 DME items, Medicare spending rates had decreased about 50 percent since 2010 while, during the same period, non-CBP Medicare spending had increased by 24%, with no significant negative changes in beneficiary health outcomes.  (Many in the disability and rehabilitation community would argue this point.)  MedPAC’s staff stated that Medicare could have saved approximately $47 million in 2015 if Medicare rates were equal to median private payer rates for off-the-shelf orthotics alone.

The presentation concluded with the issuance of two policy options for the Commission to consider, one to expand the use of CBP to more items of DMEPOS, and to reduce payment rates for certain non-CBP products annually until they are in line with private rates. To protect beneficiaries from adverse balance billing practices, MedPAC recommended placing a cap on balance billing and paying non-participating suppliers 5% less than participating suppliers.  NAAOP will be monitoring this debate closely and will address significant concerns with MedPAC along with its Alliance partner organizations.

  • Written by NAAOP

BIPA Section 427 Update and Other Health Care Developments

There were significant developments on health care issues this month, both broad and narrowly focused on O&P Care.  First off, the Senate was not able to muster a majority to pass the so-called Graham/Cassidy ACA repeal and replace legislation, which means that for the foreseeable future, persons in need of orthotic and prosthetic care will be able to access coverage under Medicaid and private, individual insurance.  This is because O&P care is typically considered an essential health benefit under the Affordable Care Act.  In related news, the House and Senate are moving closer to reauthorizing the Children’s Health Insurance Program (CHIP) for a 5-year period.  CHIP covers over 9 million children with health insurance that includes coverage of O&P care.

With respect to BIPA Section 427, CMS announced that it is “withdrawing” the proposed rule published on January 12, 2017, comments for which were due in March.  CMS received over 5,000 comments and the strongest objections came from physicians, PTs, and OTs, who arguably were exempted from the rule by statute.  By mandating that these providers obtain state licenses to provide O&P care or get certified by ABC or BOC, CMS generated tremendous opposition to the proposed rule.  In the end, these organizations overwhelmed CMS and were able to convince the Trump Administration to pull the rule in the name of regulatory relief.

There is no way paint a rosy picture of this development.  After years spent trying to finally get CMS to issue these regulations in final form, this is a significant step backwards.  However, there are some glimmers hope that we hope to build on.  First, the announcement stated that the rule was being withdrawn to “assure agency flexibility in re-examining the issues and exploring options and alternatives with stakeholders.”  We have already communicated with CMS and plan to meet with them soon to discuss how to proceed from here.

Second, this development heightens the need to rally behind passage of the Medicare O&P Improvement Act (S. 1191 and H.R. 2599) which includes provisions compelling CMS to finally issue regulations interpreting Section 427 of BIPA.  The bill explicitly exempts physicians, PTs and OTs, which would remove the majority of the opposition to the rule.  NAAOP will continue to work for passage of the O&P Medicare Improvement Act and seek alternative ways to implement the letter and spirit of BIPA Section 427.

  • Written by NAAOP

Congress Returns to Packed Legislative Agenda

Congress Returns to Packed Legislative Agenda

As Congress returns to Washington in the month of September, it faces a daunting set of challenges. The federal debt limit needs to be increased in order for the federal government to continue meeting its financial obligations. The federal government’s agencies need to be funded by October 1, 2017 or the government will shut down, and the State Children’s Health Insurance Program (SCHIP) needs to be reauthorized by the end of September or authority to run SCHIP will expire.

Complicating this packed legislative agenda is the need for federal funding to address the immediate and ongoing needs created by Hurricane Harvey.   The O&P community will be discussing the profession’s response to this colossal storm and seek ways to assist those impacted.  More to follow….

Several orthotic and prosthetic policy issues continue to be front and center for NAAOP.  CMS recently signaled that it may withdraw BIPA section 427 regulations linking provider and supplier qualifications with Medicare billing privileges. While it appears that CMS has not yet made a final decision, NAAOP and its Alliance partners are working hard to ensure that CMS presses forward with final publication of regulations involving this section of the law, which was passed 17 years ago but never implemented in full.

The Interagency Workgroup on Lower Limb Prosthetics, which was convened in the wake of the draft local coverage determination (LCD) for lower limb prostheses is expected to release a consensus statement at some point in the near future.  However, timing on this is still unclear. Once the Workgroup releases its statement, NAAOP will submit public comments on it.

Meanwhile, Congress continues to address O&P legislation by passing in the House legislation to recognize the relevance of prosthetists’ and orthotists’ clinical documentation as part of the patients’ medical records for purposes of determining the medical necessity of submitted claims. NAAOP is working with its Alliance partners to ensure that Congress passes this provision, along with other aspects of the Medicare O&P Improvement Act this year.

NAAOP also continues to work toward passage of the Injured and Amputee Veterans Bill of Rights, H.R. 2322, which is designed to educate veterans of their rights to quality O&P care and enable them to become their own best advocate in securing such care.

Finally, NAAOP acknowledges and congratulates AOPA on its 100th Anniversary, a true milestone.  We are also very proud to recognize our own 30-year anniversary as NAAOP. Our unending gratitude goes out to our members and supporters who have enabled us to speak on behalf of O&P practitioners and the patients they serve for the past three decades.

  • Written by NAAOP

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.
  1. 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.
  • Written by NAAOP

Congressional Briefing on the Value of Rehabilitation and Habilitation

Please see linked below the video to the entire one-hour Congressional Briefing on the Value of Rehabilitation and Habilitation Services and Devices in America’s Healthcare System held on earlier this week in the Dirksen Senate Office Building:

Table of contents

  • Peter Thomas begins the briefing
  • At 3:24, Senator Tammy Duckworth (D-IL) begins speaking
  • At 11:38, Representative Glenn Thompson (R-PA) begins speaking
  • At 23:58, Eric LeGrand begins speaking
  • At 32:53, Roseann Sdoia begins speaking
  • At 45:45, Lisa Smith begins speaking
  • At 51:06, Gregory J. O’Shanick, MD begins speaking
  • At 54:49, Peter Thomas begins the conclusion of the briefing

Thank you for your continued advocacy!

  • Written by NAAOP

SPECIAL ALERT:  Senate Health Reform Bill and Congressional Briefing

The Senate is scheduled to vote this week on its ACA Repeal and Replace legislation which was released in draft form on Thursday.  The bill would undermine essential health benefit coverage, including orthotic and prosthetic coverage, in the private insurance market and under the Medicaid program.

NAAOP is taking a lead role in working with a large group of rehabilitation and disability organizations to conduct a Congressional Briefing on the “Value of Rehabilitative and Habilitative Services and Devices in America’s Health Care System” along with over fifty Senate staff visits to drive home our message.

The briefing will be live streamed and will be available for viewing on NAAOP’s website at www.naaop.org.  The briefing is on Tuesday, June 27, 2017, from 12:15 to 1:30 p.m.  Special guests include Sen. Tammy Duckworth, Cong. Brian Mast, and others who will tell their story of injury, recovery, and the importance of rehabilitation services and devices.

  • Written by NAAOP

O&P Legislative Call to Action! Help Build Support for O&P Priorities

In the wake of the O&P Policy Forum in Washington, DC, organized by AOPA, we ask all NAAOP members and friends to write to their Congressman and/or Senators to seek cosponsors for two important pieces of O&P legislation. Both bills have been introduced in previous Congresses but remain priorities for the O&P profession. We need to build cosponsors of these bills to get them moving through Congress. Here’s how you can help.

  1. Go to the NAAOP website at naaop.org and click on the Congressional Action Center. This will take you to two template letters, one for each bill.
  2. Follow directions within the site to send electronic versions of a letter to your Congressman on the first bill below and your two Senators and Representative on the second bill below. Modify the template letters to your liking and send them electronically to Capitol Hill asking them to cosponsor these bills.
  3. If you are able, please call the Capitol Switchboard at 202-225-3121 and ask them for your Congressman’s or Senator’s office. Ask to speak with the health legislative assistant and leave a message that you just sent them an email on important legislation and hope they will consider cosponsoring the bill(s).
  • Injured and Amputee Veterans Bill of Rights (H.R. 2322): This legislation is spearheaded by NAAOP and was recently introduced by Congressman Tim Walberg (R-MI). The VA Bill of Rights seeks to educate veterans of their rights to help them to become their own best advocate on their VA prosthetic care. This bill requires the VA to post a list of rights in every O&P clinic across the country as well as the VA website and include the right to obtain appropriate prosthetic technology, access the practitioner of the veterans’ choice, and to obtain a second opinion if the veteran disagrees with the VA prescribed treatment plan. All of these rights are consistent with the VHA Handbook and Congressional testimony presented by VA officials in recent years and should not cost the VA more than they currently spend on O&P services.
  • Medicare O&P Improvement Act (S. 1191 and H.R. 2599): The Medicare O&P Improvement Act includes important legislative proposals that would:
    • Recognize that the prosthetist’s/orthotist’s notes are considered part of the medical record
    • Separates DME from O&P in federal regulations
    • Directs CMS to fully implement Medicare law requiring O&P qualifications in  order to be reimbursed by the program for custom O&P care
    • Clarifies “off-the-shelf” orthotics to restore Congressional intent, and
    • Mandates that HHS refine its data on O&P audits and appeals to better track reversal rates and other important information throughout the appeals process.

Thank you for your efforts for the O&P profession and the patients we serve!

  • Written by NAAOP

VA Bill of Rights Reintroduced: Help Build Support!

NAAOP is pleased to announce that the Injured and Amputee Veterans Bill of Rights has been reintroduced in the 115th Congress as H.R. 2322! We thank Congressman Tim Walberg (R-MI) and several bipartisan cosponsors of the legislation from North Carolina for their support for this important legislation.

The Injured and Amputee Veterans Bill of Rights is not new legislation. It has been introduced in prior Congresses and even passed once in the House but did not make it through the Senate before Congress adjourned. The bill is designed to educate veterans with limb loss and other orthopedic injuries of their right to quality prosthetic and orthotic care. The bill requires the VA to prominently post a list of these rights in every VA prosthetic/orthotic clinic in the country, and on the VA website, so that veterans can become more aware of their rights and become their own best advocate for their care.

Despite the best intentions of many VA officials, too many veterans experience inconsistent care across the VA and are denied access to appropriate technology, the practitioner of their choice, a second opinion for prosthetic/orthotic prescription, and other safeguards. The Injured and Amputee Veterans Bill of Rights is designed to make O&P care provided under the VA system more consistent, raise awareness of O&P standards across the country, and empower veterans to ensure they receive quality care.

WE NEED YOUR HELP in attracting as many Congressional cosponsors as possible. Please contact your Representative and ask them to cosponsor H.R. 2322, the Injured and Amputee Veterans Bill of Rights.

  1. Go to the NAAOP Congressional Action Center. You will be able to take the template letter, amend it if needed, and send it to you Representative electronically.
  2. Please call your Representative’s office and ask them to cosponsor H.R. 2322. To contact your Congressman, call your local district office or dial the Capitol Switchboard in Washington, DC at 202-225-3121, provide your zip code and you will be routed to your Representative.

Thank you for your support of NAAOP and the Injured and Amputee Veterans Bill of Rights.

  • Written by NAAOP

As ACA Repeal Vote Looms, O&P Issues Progress

The House continues to struggle to achieve enough votes within the Republican Party to repeal the Affordable Care Act (ACA) and replace it with the American Health Care Act (AHCA). Despite extensive pressure on Republican moderates, the House does not have enough votes at the present time to pass the bill and send it to the Senate for further consideration. Of greatest concern to House moderates is how the bill will impact those with pre-existing conditions and those who rely on Medicaid for their health care access. One of the biggest concerns for NAAOP is a recent amendment to the AHCA that would allow states to opt-out of providing Essential Health Benefits (EHB), which includes coverage for “rehabilitative services and devices.” This language is why the vast majority of ACA health plans and Medicaid expansion plans cover orthotics and prosthetics. NAAOP strongly supports continued access to O&P care in any bill passed by Congress on health reform.

As the ACA repeal debate continues, Medicare and other developments impact O&P:

  • Injured and Amputee Veterans Bill of Rights: NAAOP is working to reintroduce federal legislation to help educate veterans of their rights to obtain O&P care under the VA health care program. The bill seeks to make veterans aware of their right to select the practitioner of their choice and to obtain appropriate prosthetic technology that meets their needs. A new bipartisan bill is expected to be introduced soon.
  • Performant Audits: The nationwide Medicare Recovery Auditor for O&P claims (Performant) recently posted an approved issue on their website that signaled a new round of audits on knee stance flexion, HCPCS code L-5845, used with a wide variety of single axis knee codes. NAAOP and its O&P Alliance partners view the approval of this audit issue as a major overreach by Performant/CMS and have taken aggressive steps to oppose this issue and request withdrawal of this audit approval. The audit would change current Medicare coverage and coding guidance which RACs do not have authority to do. Progress is being made as Performant recently removed the audit announcement from its website without explanation.
  • LCD Legislation: In 2015, the DME MACs issued a draft Local Coverage Determination (LCD) for Lower Limb Prostheses (LLP) that would have dramatically restricted access to the current standard of O&P care. That draft LCD was placed on hold while CMS studies the issue through an Interagency Workgroup on LLP. That debacle has contributed to the reintroduction of legislation to change the LCD process. The Local Coverage Determination Clarification Act, S. 794, was recently introduced in the U.S. Senate and aims to make the LCD process more transparent and accountable. (A House bill is under development.) The bill requires public notice and comment and other processes to improve the development of LCDs, so experiences like the LLP draft LCD do not occur again. Special thanks to the Amputee Coalition for its leadership on this important bill. To send your two Senators an email encouraging them to cosponsor the legislation, go to the Congressional Action Center at www.NAAOP.org.
  • Written by NAAOP