On June 30, 2023, the Centers for Medicare and Medicaid Services (CMS) released its annual proposed rule that will establish 2024 payment rates for the Medicare Home Health Prospective Payment System (PPS). As often is the case, several important, but unrelated provisions were included in this proposed rule that will have significant impact on O&P providers and the Medicare beneficiaries they serve. The DMEPOS provisions that are included in the proposed rule are:
- 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
Of these, the proposed provision that will most likely have the greatest impact on the O&P profession is the inclusion of powered orthoses and exoskeletons in the brace benefit category for Medicare coverage and payment purposes. This represents a reversal of the long-standing CMS position that powered orthoses and exoskeletons should be classified as durable medical equipment (DME) as they generated motion across a joint without necessarily supporting a weakened joint or body member. AOPA has worked closely with its members to communicate to CMS officials the value of including these devices within the O&P benefit. This proposed rule represents a significant development that will better classify powered orthoses and exoskeletons under the Medicare orthosis benefit category. AOPA will continue to communicate issues of importance to CMS officials in hopes of more favorable outcomes like this one.
AOPA is in the process of performing an in-depth analysis of the relevant provisions of the proposed rule and will provide formal comments to CMS on the provisions that may impact AOPA members.
The proposed rule may be accessedhere.
Questions regarding the proposed rule may be directed to Devon Bernard at dbernard@aopanet.org or Joe McTernan at jmcternan@aopanet.org.