On August 6, the Senate introduced the Medicare O&P Patient-Centered Care Act (S. 4503). This bipartisan legislation would improve access to, and quality of, orthotic and prosthetic care while simultaneously combatting fraud and abuse. The Senate bill is identical to the one introduced in the House late last year (H.R. 5262). The American Orthotic and Prosthetic Association (AOPA) thanks YOU for all your efforts to get this vital legislation introduced in both the House and Senate!
To move this legislation forward, we need to garner as much support as possible for it. Please take a few minutes to write to your Representative and Senators and urge them to support this important legislation – simply enter your information in on the platform, personalize the letter as you see fit – it’s important to tell YOUR story – and click send.
These bills would:
- Distinguish the clinical, service-oriented nature in which O&P is provided from the commodity-based nature of the durable medical equipment (DME) benefit. Orthotics and prosthetics care includes a patient care component that is decidedly more in-depth and personal than simply supplying DME. Most orthotic and prosthetic devices are custom fabricated or custom fit and require the expertise of an orthotist or prosthetist who receive Master of Science degrees and residence training before becoming certified practitioners. Distinguishing O&P from DME would also create a path to billing for telehealth, which is increasingly important during the COVID pandemic.
- Restore congressional intent by revising the overly expansive regulatory interpretation of the meaning of “off-the-shelf” (OTS) orthotics to clarify that competitive bidding may only apply to orthoses that require minimal self-adjustment by patients themselves, not the patient’s caregiver or a supplier. Congress created a definition of OTS orthotics as devices “requiring minimal self-adjustment for appropriate use” that “do not require expertise in trimming, bending, molding assembling, or customizing to fit to the individual.” However, the Centers for Medicare and Medicaid Services (CMS) has changed and expanded the definition beyond Congress’ intent. CMS defines minimal self-adjustment as an adjustment the “beneficiary, caretaker for the beneficiary or supplier can perform” – which is clearly not “self-adjusted.” This expansion of Congress’ definition places beneficiaries at risk for harm if they receive orthotic devices without the services that are necessary to ensure that these devices provide proper bracing.
- Reduce the likelihood of waste, fraud, and abuse in the Medicare program by prohibiting the practice of “drop shipping” (shipping an orthoses or prostheses to a beneficiary without first receiving direct patient care from a trained, certified or licensed health care practitioner) of orthotic braces that are not truly “off-the-shelf” (i.e., subject to minimal self-adjustment by the patient him- or herself).
All it takes is a few minutes, please take the time and write your legislators TODAY and urge them to support these important bills. Educating Congress on the issues surrounding the O&P profession is vital to businesses and more importantly patients – if we don’t advocate for our needs and the needs of patients, no one will.
If you have any questions, contact Justin Beland, AOPA Director of Government Affairs, at firstname.lastname@example.org.
Thank you for your efforts!