Year: 2023

Alexandria, VA (December 11, 2023) – Today, the American Orthotic and Prosthetic Association (AOPA) is pleased to announce its 2024 Board of Directors.

The Executive Committee will consist of Mitchell Dobson, CPO, FAAOP who assumes the role of President. Along with, Teri Kuffel, JD who moves into the role of Immediate Past President and Rick Riley who was appointed to be President-Elect after Jeff Brandt, CPO stepped down on November 30. Joining them are Kimberly Hanson who was elected from the Board to serve as Vice President, and Chris Nolan who was appointed to serve as Treasurer to fill Rick Riley’s seat.

On November 1, 2023, the Centers for Medicare and Medicaid Services (CMS) released its annual final rule that established 2024 payment rates for the Medicare Home Health Prospective Payment System (PPS).  As expected, the final rule carried forward several important, but unrelated provisions that are of significant interest to O&P providers and the Medicare beneficiaries they serve.  The DMEPOS provisions that were finalized in the rule include:

• The codification and expansion of the Medicare definition of the term “brace” to include powered orthoses and exoskeletons
• Creation of a new benefit category and payment for compression garments used to treat lymphedema
• Changes to the methodology used to calculate Medicare fee schedules based on rates established through competitive bidding
• Modifications to supplier enrollment processes designed to further control Medicare fraud and abuse
• Codification of existing policy regarding documentation requirements for DMEPOS refills

Recently, the Centers for Medicare and Medicaid Services (CMS) finalized regulations that establishes operating requirements for Medicare Advantage (MA) plans operating in 2024 .  This is an annual process and AOPA provided comments last year as the rule was being drafted, but the 2024 final rule will require MA plans to operate much more similarly to the traditional, fee for service-based Medicare program.  The final regulations represent the most sweeping changes to the operating requirements MA plans must abide by and, in general, will create greater transparency and accountability to Medicare beneficiaries. 

Contact: Joy Burwell
jburwell@AOPAnet.org

FOR IMMEDIATE RELEASE

Medicare Orthotics and Prosthetics Patient-Centered Care Act Introduced in the House

Washington, DC (June 23, 2023) – Today, Representatives GT Thompson (R-PA), Mike Thompson (D-CA), Brett Guthrie (R-KY), and Angie Craig (D-MN) introduced the Medicare Orthotics and Prosthetics Patient-Centered Care Act (H.R. 4315) in the U.S. House of Representatives.

“The American Orthotic and Prosthetic Association applauds the introduction of the Medicare Orthotics and Prosthetics Patient-Centered Care Act and greatly appreciates the support and efforts of Representatives GT Thompson, Mike Thompson, Brett Guthrie, and Angie Craig” said Eve Lee, MBA, CAE, Executive Director of the American Orthotic and Prosthetic Association. “We look forward to working with Congress to pass this important piece of legislation.”

DME MACs and PDAC Announce Retirement of Correct Coding Guidance for Upper Extremity Prostheses

On March 15, 2023, the DME MACs and PDAC announced the retirement of their previously published correct coding guidance for upper extremity prostheses.  The correct coding guidance, originally published on March 31, 2022 resulted in significant concern from AOPA and its partners in the O&P Alliance about the impact the correct coding guidance was having on access to clinically appropriate, medically necessary upper extremity prosthetic care, not only for Medicare beneficiaries but also for individuals covered by other insurers who adopted the correct coding guidance into their own policy decisions.

The O&P Alliance submitted extensive written comments regarding its concern about the correct coding guidance shortly after it was published.  After several months of follow up communication, on March 9, 2023, AOPA and the O&P Alliance had a very productive meeting with CMS representatives, the DME MACs, and PDAC where we were able to reiterate our concern about the correct coding guidance and how, less than a year after its publication, it was significantly hindering access to care for Medicare beneficiaries and others.

The DME MAC and PDAC medical directors indicated that the intention of all correct coding guidance is to assist providers in understanding how to properly describe the services they are providing and explained that their guidance is never meant to create new or revised coverage policy.  The medical directors suggested that they would consider retiring the correct coding guidance if it was creating more confusion than clarification for providers and beneficiaries alike.

Less than a week after meeting with the AOPA and the O&P Alliance, the DME MACs and PDAC announced the official retirement of the previously published upper extremity prostheses correct coding guidance.  This extremely positive development shows the incredible value of open and trusted communication. There is still work to be done and collaboration will be the key but the retirement of the correct coding guidance is an important step in working toward the development of proper guidance that will ensure adequate access to clinically appropriate, medically necessary upper extremity prosthetic care for Medicare beneficiaries.

AOPA will work with its O&P Alliance partners to make sure that this great work continues.

Questions regarding this issue may be directed to Joe McTernan at jmcternan@aopanet.org or Devon Bernard at dbernard@aopanet.org.