Senate Introduces S. 2556:  Medicare O&P Patient-Centered Care Act

The Medicare Orthotics and Prosthetics Patient-Centered Care Act has been introduced in the United States Senate and referred to the Senate Committee on Finance.  This is companion legislation to H.R. 1990, an identical bill in the U.S. House.  Both bills are bipartisan with the Senate bill being introduced by six original sponsors of the legislation, including:

  1. Senator Mark Warner, a Democrat from Virginia who serves on the Finance Committee;
  2. Steve Daines (R-MT), also a Finance Committee member;
  3. Tammy Duckworth (D-IL), a champion of the O&P profession and prosthetic user;
  4. John Cornyn (R-TX), a senior Republican on the Finance Committee;
  5. Bill Cassidy (R-LA), a physician on the Finance Committee, and
  6. Charles Grassley (R-IA), former Chairman of the Finance Committee and long-time champion of O&P legislation.

The bill would accomplish four key priorities for the orthotic and prosthetic profession:

  • Distinguishes durable medical equipment (DME) from clinical O&P care
  • Limits the definition of “off-the-shelf” (or “OTS”) orthotics to devices that truly require only “minimal self-adjustment” by the beneficiary only
  • Bans drop-shipping to patients of custom fit and custom fabricated orthoses and prostheses to ensure access to clinical care, and
  • Exempts licensed and certified O&P practitioners from OTS competitive bidding, treating them similarly to physicians and therapists by allowing them to provide OTS orthoses to their patients without a contract at the competitive bidding rate.

Now we need YOUR help to build support for this legislation.  Please visit our action page to easily email your Senators and ASK THEM TO COSPONSOR THIS BILL simply by filling in your contact information and selecting your Senators. We urge you to take the time to customize your message to inform your Senator how this bill impacts you and your colleagues in the state.

If you have not contacted your Congressman, please take this opportunity to also reach out to that office and encourage them to cosponsor companion legislation in the House, H.R. 1990.  You can identify your Congressmen, Senators, and learn how to easily communicate with them at www.NAAOP.org.

NAAOP thanks the American Orthotic and Prosthetic Association (AOPA) for its efforts in getting this bill introduced in the Senate.  We also thank our O&P Alliance partners for their support of this important bill.

Finally, thank you for your continued support of NAAOP and policies to advance the O&P community!

 

  • Written by ITOperations

Virtual Advocacy Offers O&P Community New Tools to Advance Legislation

 

The COVID-19 pandemic’s lasting effects will be felt world-wide and its impact on Washington advocacy is no exception.  Flying to Washington to walk the halls of Congress will return over time as the primary way to impact legislators, but virtual advocacy, in some form, is here to stay and it offers the O&P community new tools to achieve its legislative objectives.  We urge practitioners and patients alike to go to www.NAAOP.org and access the “Congressional Action Center” to connect with your representatives.  You should feel empowered to directly seek a videoconference with your Member of Congress or staff to promote two important bills:

  1. Medicare Orthotics and Prosthetics Patient-Centered Care Act (H.R 1990)

Representatives Mike Thompson (D-CA), GT Thompson (R-PA), GK Butterfield (D-NC), and Brett Guthrie (R-KY) have re-introduced this bipartisan bill in the House.  A Senate companion bill is expected to be re-introduced in early June.  NAAOP strongly supports this legislation and we need to demonstrate support for this bill by adding Congressional cosponsors to it. The bill is identical to the House version of the bill (H.R. 5262) introduced last year, which means we can build on the awareness and support for the bill from the previous Congress.

The bill would accomplish four key priorities for the orthotic and prosthetic profession: (1) Distinguish durable medical equipment (DME) from clinical, service-oriented O&P care in the Medicare statute and regulations, (2)  Limit the definition of “off-the-shelf” (or “OTS”) orthotics to devices that truly require only “minimal self-adjustment” by the beneficiary him- or herself, (3) Ban drop-shipping to patients’ homes of custom fit and custom fabricated orthoses and prostheses to prevent fraud and abuse and ensure patient access to clinical O&P care, and (4) Exempt licensed and certified O&P practitioners from OTS competitive bidding, treating them similarly to physicians and therapists by allowing them to provide OTS orthoses to their patients—without a contract—at the competitive bidding rate (not the higher fee schedule amount).

  1. “Triple A” Study Act (S. 1089 and H.R. 2461)

Senators Tammy Duckworth (D-IL) and Marsha Blackburn (R-TN) and Representatives G.K. Butterfield (D-NC-01) and Brett Guthrie (R-KY-02) recently introduced the Access to Assistive Technology and Devices for Americans Study Act, known as the “Triple A” Study Act.  This bill is identical to the Senate (S. 4343) and House (H.R. 8581) versions of the bills introduced last year, which means we can build on the awareness and support for the bill from the previous Congress.  The bill would direct the Government Accountability Office (“GAO”) to craft a report evaluating appropriate coverage and provision of health care services to people with limb loss or limb difference, including access to care, policies for matching specific devices to individual needs, affordability, and more. In addition, it would create an “apples to apples” comparison of coverage policies and usage across different payers, including Medicare, the Veterans Health Administration, and the commercial insurance market.

We urge all NAAOP members and friends to contact their legislators and ask them to cosponsor both of these important bills.  Thank you for your advocacy on behalf of the O&P profession.

  • Written by ITOperations

NAAOP and Range of Motion Project celebrate Limb Loss Awareness Month

NAAOP is proud to partner with the Range of Motion Project (ROMP) for Limb Loss Awareness Month as part of their national component collection drive.

 

Launching in April, and continuing throughout this spring, ROMP is collecting new and gently used prosthetic components from clinics, manufacturers, and individuals throughout the United States to ensure ROMP’s clinics in Guatemala and Ecuador can continue to provide high-quality prosthetic care to access-limited people with amputation. This is part of ROMP’s Components for a Cause (C4C) year-round component recycling program.

 

Nicole Ver Kuilen, NAAOP’s Inaugural Fellow and Consumer Vice President, is helping to lead this effort with ROMP. Ver Kuilen shared, “April is Limb Loss Awareness Month and it’s critical we acknowledge the fact that 9 out of 10 amputees worldwide do not have access to prosthetic care. This month, we can do something about that.” 

 

ROMP will cover the cost of shipping and donated components will go directly to use in changing someone’s life. It’s as simple as signing up and requesting a free shipping label! Recently, ROMP implemented a QR code tracking system to increase transparency and impact. Every knee, foot, and liner donated is tracked all the way to the patient, so donors know exactly who they’ve helped become mobile.

 

“What better way to help those with limb loss during this important month for the O&P community than through this project that our first Fellow is working on. NAAOP and our Board of Directors congratulate every organization and individual involved in making the lives better for those with limb loss worldwide,” shared George Breece, Executive Director of NAAOP.

 

ROMP now has over 150 clinic partners in the United States who have joined the movement for equitable access to prosthetic care. This represents just 5% of clinics nationwide, which is why ROMP is calling for hundreds more to join in the effort. In 2020, ROMP collected over 5,000 pounds of components and hopes to collect 7,000 pounds in 2021. 

 

Dave Krupa, CPO and ROMP Executive Director and Co-Founder shared, “Since 2005, ROMP has been working with the most marginalized individuals in the Americas who would otherwise not have access to prosthetic care. We are proud to share that we just surpassed our 4,000th prosthesis delivered in 2021. This journey would not be possible without ROMP’s C4C donors and partners like NAAOP who are dedicated to breaking down economic and systemic barriers that keep individuals from obtaining the freedom that comes from mobility. We believe in mobility for all.”

 

About NAAOP

The National Association for the Advancement of Orthotics and Prosthetics is a non-profit trade association dedicated to educating the public and promoting public policy that is in the interest of the O&P patient. Since 1987, NAAOP has shaped positive results in healthcare legislation and regulation through strong government relations advocacy and education of policymakers. NAAOP serves the profession by representing and partnering with only those providers of orthotic and prosthetic services who truly believe that the patient must come first. For more information please visit: https://naaop.us/

 

About ROMP

The Range of Motion Project is a global, non-profit organization dedicated to improving the mobility of people with amputation. ROMP realizes its mission by providing high-quality prosthetic care, follow up services, community-based rehabilitation, and product innovation through its permanent operations. Since 2005, ROMP has delivered over 4,000 custom-made, high-quality prosthetic devices in Guatemala, Ecuador, and the U.S., and conducted over 10,000 patient visits. In the next 5 years ROMP plans to raise $5 million dollars to deliver 5,000 prosthetic devices to those in need. To learn more or help advance their mission, please visit https://www.rompglobal.org/.

 

  • Written by ITOperations

O&P Alliance Positive Workplace Culture Guide

 

The Alliance Subcommittee on Sexual Harassment has worked hard to combat sexual harassment in the O&P field. We are eager to hear your feedback as we plan our programs for 2021. Please click the link below to participate in the short survey that should take less than 5 minutes to complete

Sexual Harassment Survey

 

The mission of the NAAOP is to be a strong, unifying advocate, representing the interests of the O&P patient and practice communities specifically championing causes concerning patient access, funding, and outcomes through leadership in national and state policy formation. We will be the collective voice of our constituents by achieving high quality patient standards through support and empowerment of the clinician-patient partnership. One way we can achieve this mission is by continuing to strengthen and support the O&P community through providing resources to prevent and address harassment in all forms, including sexual harassment, within our field. The members of the O&P Alliance are united in condemnation of sexual misconduct, harassment, and discrimination, and have issued an open letter affirming this position, which is linked below. To further support the profession and the patients we serve, the Alliance has developed the enclosed resource list, which includes relevant materials in various formats along with topic summaries to help guide website visitors. We stand united in fostering a dialogue on this important issue and creating an environment of respect, support and progress.*

Maggie Baumer, JD
Chair, Alliance Subcommittee on Sexual Harassment

Resources by Category

The members of the O&P Alliance are united in condemnation of sexual misconduct, harassment, and discrimination, and have issued an open letter affirming this position, which is linked below. To further support the profession and the patients we serve, the Alliance has developed the enclosed resource list, which includes relevant materials in various formats along with topic summaries to help guide website visitors.*

 

  1. Alliance Open Letter
    • “An Open Letter About Discrimination in O&P.” NAAOP, December 10, 2018. Video by Peter Thomas.
    • “An Open Letter About Discrimination in O&P.” The O&P Edge, December 10, 2018. Article.
  1. Policies/Codes of Conduct/Codes of Ethics

  1. Educational Webinars/Live Presentations

    • AAOP, Meyer, Katie. “2019 Wellness Track – WP2: Harassment in the Workplace.” AAOP 45th Annual Meeting and Scientific Symposium, March 6 – 9, 2019. Presentation, (new state of harassment after the initiation of the #MeToo movement, current interpretation of federal and state laws versus interpretations from decades past, two main forms of sexual harassment: 1. Quid Pro Quo [e.g., this for that – demanding/requesting sexual favors in exchange for professional advancement, etc.]; 2. Hostile Work Environment).
    • AAOP, “Virtual Roundtable Discussions: Workplace Harassment Awareness and Prevention.” Sponsored by The Academy’s Women in in O&P Committee, November 22, 2019. Podcast.
    • ABC, “Harassment in the Workplace.” January 17, 2019. Podcast, (also with Katie Meyer, same topics as AOPA presentation).
    • AOPA, Davis, Melvin & Perrone, Joyce. “Defining, Mitigating and Reducing Harassment in the Workplace.” Healthcare Compliance in Ethics Week, AOPAversity, November 4 – 10, 2018. Webinar, (importance of updated info in current climate, hostile work environment, best defense is zero tolerance, employer’s duty of reasonable care and corrective action, #MeToo, common misconceptions, case examples).
    • AOPA, “Employment Practices Liability.” Harassment, Discrimination and Wrongful Termination Session, 2018 National Assembly. Webinar, (Gen X, Gen Y, employer liability, federal laws, wages and hours, third party claims, liability insurance, risk management services).
  1. Power Point Presentation/Educational Materials

    • BOC, “Participant’s Guide to Preventing Harassment.” PDF, (definitions, legal guidelines, costs of harassment, prevention, barriers to taking action, final quiz).
    • BOC, “Preventing Harassment.” Power Point, (overview of harassment and definitions, harassment categories, legality versus inappropriateness, verbal versus physical, case studies).
    • EEOC, Feldblum, Chai & Lipnic, Victoria. “Rebooting Workplace Harassment Prevention: Highlights of the Report by Commissioner Chai Feldblum & Acting Chair Victoria Lipnic.” June 2016. Power Point, (types of harassment, workplace risk factors, underreporting, retaliation, intimidation, fear, role of employers, illegality of harassment, financial costs to businesses, impact on health of employees, leadership can change culture – no tolerance, risk factors, holistic approach, reporting and investigation, training, civility training, bystander intervention training).
    • NCOPE, “2019 Mentor Short Program.” 2019. Power Point, (communication skills, mentor vulnerability, moving away from “tough love” approach, general guidelines for promoting adult learning).
  1. Articles

    • ABC, “Harassment in the Workplace.” Mark of Merit Newsletter, December 2018, pp. 3-4. PDF, (role of bystanders and the role of leadership in prevention; policy, procedure, investigation, plan for disciplinary action).
    • ABC, “Harassment in the Workplace Series: Part 2 – We’re All in it Together.” Mark of Merit Newsletter, June 2019, pp. 1-3. PDF, (beliefs that sexual harassment is common but belief that it is not happening in our own workplace, most people who experience harassment do not report it, O&P profession is no different, ABC disciplinary process, necessity for cultural shift).
    • Rosenfeld, Larry. “Discrimination and Sexual Harassment Policies.” Entrepreneur. Website, (companies with 15 or fewer employees exempt from federal discrimination laws, juries tend to award plaintiffs high monetary damages, low cost options for employers, creating a policy and identifying what should be included, policies aid in prevention).
    • Trotter, Richard & Zacur, Susan Rawson. “Corporate Sexual Harassment Policies: Effective Strategic Human Resource Management.” Journal of Business & Economics Research, 1, 2004, vol. 2, no. 3. Web Article, (circumstances in which employers are held liable for sexual harassment, definition of harassment, examples of conduct, guidelines for victims of harassment, who to report to, distribution of policy, conducting investigation, corrective action, training).
    • Watson, Carol. “#MeToo but #WhatDoWeDoNow.” Diversity Best Practices. (fostering mutual respect, achieving gender equity, and instilling a culture of inclusion; ensuring gender-balanced discussions, tips on facilitating an open dialogue, resources for engaging men in #metoo discussions, power and hierarchy play a role, some actions to consider including, clearly articulate position, policies and penalties, revisit sexual harassment training).
    • Williamson, Scott. “8 Tips for Talking About Sexual Harassment With Staff.” OPIE Choice, December 14, 2017. Web Article, (goal of policy, sharing of personal experiences, expect the uncomfortable, listen, assume positive intent, take the pressure off, have language ready, put yourself in other person’s shoes).
    • “A Toolbox for Ethical O&P Workplaces.” O&P Almanac, May 2018, pp. 23-24.  Web Article, (implementing written policies, designating a compliance officer, conducting effective training and education, developing effective lines of communication, enforcing standards through well-publicized disciplinary guidelines, conducting internal monitoring and auditing, responding promptly to detected offenses).
    • “Association Issues Comments on Ant-Harassment Open Letter.” O&P Edge, December 11, 2018. Web Article, (recap of Open Letter from Alliance and comments from each Alliance member organization).
  1. Websites

    • American Sociological Association. “ASA Anti-Harassment Resources.” (campus leaders, academic meetings, research on sexual harassment at conferences, sociology, nationwide, federal government, training programs, reports about harassment at academic meetings, other reports about harassment, current conversations).
    • “Sexual Assault Resource Guide.” (Overview, what to do, crisis hotlines, online forums and support, what’s considered assault? If you want medical care, if you want a “rape kit,” if you want to make a police report, if you want legal support, if you want a therapist, long-term recovery, if you’re worried about a loved one).
    • Lean In. “Lean In: Dealing with Sexual Harassment for Individuals. Advice Information and Support for Harassment Survivors and for Anyone who wants to Help.” (Understanding the issue, discussion guides, facts about sexual harassment, sexual assault and the LGBTQ community, not just the rich and famous – the pervasiveness of sexual harassment across industries affects all workers, practicing self-care, knowing your options, helping others, know you’re not alone).
    • National Women’s Law Center. “NWLC Resource: That’s Harassment.” (10 Ways to help your company prevent harassment, sample quarterly anti-harassment check-in, recommended practices of employers when a high-profile individual is accused of harassment, resources for employees).
    • Society for Human Resource Management (SHRM). “Workplace Harassment Training Resources.” (How to revamp your harassment prevention program, training that doesn’t work, separate sexual harassment training for managers, ethics and compliance training courses).
    • Society for Human Resource Management (SHRM). “Workplace Harassment Compliance Resources.” (Don’t make harassment claims subject to arbitration, 5 ways to strengthen your anti-harassment complaint procedure, quiz: is it sexual harassment?, 5 effective ways to upgrade your policy, different types of sexual harassment, Me Too or Not Us?, omissions to policies that make them ineffective, 13 non-defenses to workplace harassment).
    • S. Equal Employment Opportunity Commission. “Promising Practices for Preventing Harassment.” (Leadership and accountability, comprehensive and effective policy, effective complaint system, effective harassment training).
    • S. Equal Employment Opportunity Commission. “Facts About Sexual Harassment.” (Who is victim, who is harasser, unwelcome conduct.)
    • Women in Research. “Workplace Resources: Sexual Harassment and Assault.” (recommended staps for protecting yourself and dealing with sexual harassment in the workplace, review handbook and policies, tell the harasser that the behaviors are unwanted and must stop, report your concern to your manager, resources in the U.S., Australia, E.U., U.K., Japan and other areas).

 

American Academy of Orthotists and Prosthetists (AAOP), Email: info@oandp.org

American Board for Certification in Orthotics, Prosthetics, and Pedorthics (ABC), Email: info@abcop.org

American Orthotic & Prosthetic Association (AOPA), Email: info@aopanet.org

Board of Certification/Accreditation (BOC), Email: info@bocusa.org

National Association for the Advancement of Orthotics and Prosthetics (NAAOP), Email: info@naaop.org

National Commission on Orthotic and Prosthetic Education (NCOPE), Email: info@ncope.org

* These resources are provided as general information and are not intended as legal advice related to individual situations. For this reason, we advise you to consult with your own attorney and/or other advisor regarding specific circumstances and concerns.

  • Written by ITOperations

House Introduces Medicare O&P Patient Centered Care Act!

Representatives Mike Thompson (D-CA), GT Thompson (R-PA), GK Butterfield (D-NC), and Brett Guthrie (R-KY) have re-introduced the bipartisan Medicare Orthotics and Prosthetics Patient-Centered Care Act (H.R 1990).  NAAOP strongly supports this legislation along with the organization that took the lead on introduction of this legislation, AOPA, as well as the other members of the O&P Alliance.

The bill is identical to the House version of the bill (H.R. 5262) introduced last year, which means we can build on the awareness and support for the bill from the previous Congress.  The bill would accomplish four key priorities for the orthotic and prosthetic profession.  It would:

  • Distinguish durable medical equipment (DME) from clinical, service-oriented O&P care in the Medicare statute and regulations, leading to recognition of the clinical care O&P practitioners provide.

 

  • Limit the definition of “off-the-shelf” (or “OTS”) orthotics to devices that truly require only “minimal self-adjustment” by the beneficiary him- or herself. This would help ensure that patients continue to have access to the clinical orthotic services they need.

 

  • Ban drop-shipping to patients’ homes of custom fit and custom fabricated orthoses and prostheses to prevent fraud and abuse and ensure patient access to clinical O&P care, and

 

  • Exempt licensed and certified O&P practitioners from OTS competitive bidding, treating them similarly to physicians and therapists by allowing them to provide OTS orthoses to their patients—without a contract—at the competitive bidding rate (not the higher fee schedule amount).

Now we need your help to build support for this legislation.  Please visit NAAOP’s website and access our action page to easily email your Representatives and ask them to cosponsor this bill simply by filling in your contact information and selecting your Representative to send the message to. If you can customize your message to discuss how this bill impacts you, all the better.

Thank you for your continued support of NAAOP and policies to advance the O&P profession!

 

 

  • Written by ITOperations

Harassment Education – Request for Feedback

 

The Alliance Subcommittee on Sexual Harassment has worked hard to combat sexual harassment in the O&P field. We are eager to hear your feedback as we plan our programs for 2021. Please click here and participate in the short survey that should take less than 5 minutes to complete

 

 

 

  • Written by ITOperations

New Congress and Administration Get Started

 

Election Impact:  The January run-off elections in Georgia flipped control of the U.S. Senate to Democratic control, propelling Senator Chuck Schumer to Majority Leader and casting Vice President Harris as the vote that will likely break many ties in the next two years.  This unlikely result means Democrats control the House, Senate and Executive Branch, with Joe Biden being sworn into the Presidency on January 20th.  Razor thin margins in both the House and Senate spells difficulty for progressive policies like Medicare for All, creation of a public insurance option, and even lowering the Medicare age to 60 years old.  Bipartisanship will be at a premium, but with a budget process known as “reconciliation,” which requires only 51 votes in the Senate to pass certain legislation, there is still a lot of opportunity to achieve O&P objectives.  And the Biden Administration is showing signs of being very active on health policy, which does not require Congress’ approval.

 

O&P Legislation:  With all of the key House and Senate champions of the Medicare O&P Patient-Centered Care Act returning to Congress, quick reintroduction is expected in the coming months.  The bill would separate DME from O&P, reform the definition of off-the-shelf (OTS) orthotics, exempt licensed and certified orthotists and prosthetists from competitive bidding, and ban drop shipping of custom O&P to patients’ homes.  The bill will continue to compete with COVID-19 relief legislation which will take most of the oxygen out of the Congressional agenda, but legislative vehicles on which to attach this bill will be available later this year and next.  In addition, the “Triple A” Study Act, which would dramatically improve the data the profession has on O&P prevalence, use, and insurance coverage, is also expected to be introduced in the coming months.  NAAOP supports both of these bills and urges our members to request their Members of Congress to become cosponsors of the bills.

 

DMEPOS Proposed Rule:  In the closing days of the Trump Administration, CMS collected comments on its CY 2021 Proposed Rule on Durable Medical Equipment, Prosthetics, Orthotics, and Supplies, but did not have time to issue a final rule.  There were several important proposals in this year’s rule—which is currently on hold until the Biden Administration decides how it wants to proceed.  Of particular note in the proposed rule are the improvements to the HCPCS coding and pricing processes, including the way CMS determines the benefit category of new technologies.  NAAOP will be closely monitoring this rule and will report new developments to the NAAOP membership.

 

Veterans Administration Final Rule on Prosthetics:  In late December, the VA finally issued its final rule on prosthetics, clarifying that veterans do, in fact, have a role in deciding which practitioner will be able to provide their care.  But the final rule still grants the VA authority to make this determination.  Since NAAOP spearheaded the Injured and Amputee Veterans Bill of Rights, NAAOP has made veteran choice of practitioner a top priority.  For this reason, NAAOP will continue to closely monitor this situation and will intervene further if necessary.

Sexual Harassment:  Maggie Baumer, J.D., President-Elect of NAAOP, has been chairing an O&P Alliance Subcommittee on Sexual Harassment.  Look for the NAAOP video coming soon that will feature Maggie as she reports on the status of this important initiative and seeks further engagement in this issue across the O&P profession.

  • Written by ITOperations

NAAOP Hosts Virtual Congressional Fly-In to Advocate for O&P Legislation

On December 8, 2021, NAAOP hosted a Congressional “Fly-In” to advocate for passage of orthotic and prosthetic legislative priorities. The event was virtual and designed as a “pilot” to assess the feasibility of conducting such events in the future. The pandemic has made telephonic visits to Capitol Hill offices much more common, and this enabled NAAOP to proceed with this event. Over twenty board members, NAAOP fellows, and members in key Congressional districts participated in over 30 meetings with Congressional leaders. The timing of this advocacy event could not have been better, with Congress poised to pass a massive, year-end spending bill to fund the federal government and debating a major COVID-19 relief package. These pieces of legislation are considered “must-pass” which presents an opportunity to attach O&P-specific bills to this legislative vehicle.

NAAOP focused on three issues, passage of the Medicare O&P Patient-Centered Care Act, passage of the “Triple A” Study Act, and introduction to a new issue, the importance of recognizing the medical necessity of prosthetic limbs and other technologies to enable people with disabilities to exercise and remain fit and healthy. NAAOP members and friends who wish to help advocate for passage of the two bills can go to the Legislative Action Center on the NAAOP website at www.naaop.org.

In virtually all of our Congressional meetings, the three issues we discussed were well received and there is reason to be optimistic for action on this legislation in the future. However, these bills are not necessarily considered linked to COVID-19 and, therefore, not necessary to include in the end-of-year packages. There are so many pressing matters before Congress that several champions of our legislation cautioned that inclusion of our provisions in year-end bills would be a huge lift, notwithstanding their support for the contents of our proposals.

The Patient-Centered Care Act is bipartisan and has champions on both sides of Congress. A Congressional Budget Office estimate of its cost is not yet complete and this is a necessary step for Congress to proceed. If action is not taken this year to advance that bill, AOPA has learned—and the lead sponsors NAAOP met with confirmed—that this legislation will be re-introduced in the new Congress. The Triple A Study Act was introduced in August 2020 at the behest of the Amputee Coalition. Our advocacy centered around building awareness of and support for the legislation and the value of obtaining the wealth of information on O&P insurance coverage, demographics, and access to care the bill would produce. NAAOP also highlighted a position statement and policy paper from Nicole Ver Kuilen, NAAOP board member and Inaugural NAAOP Fellow, on the right of people with disabilities to exercise. The issue received broad support and encouragement to return to the next Congress to discuss further.

NAAOP would like to thank all of those who participated in this successful advocacy event on behalf of the O&P profession and the patients we serve.

  • Written by ITOperations

Election Results Set Stage for Health Care Policy Changes

2020 Election: President-Elect Biden’s win in the 2020 election was muted by weeks of controversy over vote counts and legal challenges but the transition to a Biden Administration is now underway. The expected “blue wave” did not materialize as some expected, with Democrats losing several seats in the House, making the 117th Congress one of the slimmest Democratic margins in recent memory. Senate Republicans lost one seat and retain control of that chamber to date, but two runoff elections scheduled for January 5th in Georgia will determine whether Republicans or Democrats control the Senate. If Democrats win both seats, an unlikely prospect, Democrats will be able to pass budget legislation with a simple 51-vote majority, but most legislation will still require bipartisan cooperation to prevent a 60-vote Senate filibuster. Either way, the mixed results place tremendous emphasis on the need for bipartisan cooperation.

Prior Authorization: Prior authorization of six lower limb prosthetic HCPCS codes will be implemented nationwide on December 1, 2020 as the four-state pilot program, which began September 1st, is expanded. By all accounts, the program has been more successful than expected, with relatively quick prior authorization approval times. The upside of prior authorization is that claims for payment are afforded some degree of finality, with less risk that such claims will be audited by Medicare contractors and the funds recouped. If you experience problems with the nationwide rollout of prior authorization, please report your experiences to NAAOP and ask your patients to call 1-800-Medicare to lodge a complaint with the program.

OTS Competitive Bidding: The Medicare program is pressing forward with implementation of competitive bidding of certain off-the-shelf (“OTS”) orthotics in 127 competitive bidding areas (“CBAs”) throughout the United States on January 1, 2021. Despite requests to delay the program due to the pandemic and the lack of sufficient notice to providers, CMS is rolling out the program which applies to 23 HCPCS codes for OTS knee and back braces. The program was able to achieve, on average, 30% to 35% reductions in reimbursement amounts, varying by geography. According to Medicare data, certified and/or licensed orthotists provide less than 20% of these orthoses, with physicians, therapists, DME suppliers and pharmacies providing the bulk of these orthoses. Claims submitted for these 23 OTS codes will not be paid if the supplier does not have a competitive bidding contract.

NAAOP Virtual Congressional Fly-In: NAAOP is hosting a “pilot” virtual Congressional Fly-In to promote passage of O&P legislation including the Medicare O&P Patient-Centered Care Act (S.4503) and the Triple A Study Act (S. 4343). The Fly-In is a pilot to test the effectiveness of a virtual model as Congressional members and staff adapt to advocacy during a pandemic. Over 20 board members, NAAOP Fellows, and key NAAOP members will participate in over 50 telephonic meetings on December 8, 2020. NAAOP will assess the effectiveness of this model and decide whether to host these fly-ins in the future.

Thanksgiving: It has been a very difficult year by all accounts, but NAAOP is optimistic that better days lie ahead. We at NAAOP take this opportunity to wish all NAAOP members and friends a Happy Thanksgiving in the safest and most meaningful way possible. And, as always, we thank you for your membership and support!

  • Written by ITOperations

Health Care on the Ballot as America Votes

Health care is playing an outsized role as the 2020 election is underway and the Senate is poised to install a 6-3 conservative majority days before the U.S. Supreme Court hears arguments about the Constitutionality of the Affordable Care Act (ACA).

President Trump and former Vice President Biden face off on November 3rd but the election is already well underway.  At the time of this writing, early 18 million people have already voted in states that permit early voting.  Turnout is expected to break records.  One of the dominant campaign themes has been health care including the national response to the pandemic and the threat to health care access through challenges to the Affordable Care Act.

The Biden Campaign offers extensive detail on health care policy, including reducing the age to 60 (from 65) for individuals eligible to join the Medicare program, establishment of a “public option” for the uninsured to obtain health insurance in order to drive down the cost of health care while enhancing access, bolstering existing aspects of the ACA, reducing the cost of prescription drugs, and coordination of a national plan to combat the pandemic.

The Trump Campaign did not issue a policy platform this year so details of what a second Trump term would mean for health care policy is not entirely clear.  But it is likely the next four years would include continued efforts to reduce the price of prescription drugs, limit “surprise” medical bills, provide greater transparency in health care pricing, and implement additional reductions in regulatory burdens on health care providers.  Although the President professes strong support for protecting people with pre-existing conditions, his Administration is poised to argue before the Supreme Court that the ACA is invalid and should be entirely struck down.

An accelerated effort to replace Justice Ruth Bader Ginsburg with Judge Amy Coney Barrett is being driven, in part, by a desire to fill this court vacancy before the election and have a full court in place to hear the latest legal challenge to the ACA.  A lower Texas court determined that the ACA is invalid because Congress eliminated the monetary penalty for failure to satisfy the individual insurance mandate that is critical to achieving near universal coverage, which accompanies protections from pre-existing conditions, community rating, non-discrimination based on health status, protection from lifetime and annual caps, and other provisions.  If there is no monetary penalty for failing to have insurance, the Texas court argued, then Congress’ authority to pass the ACA based on its taxing power is invalid.  The lower court struck down the entire 1100-page law but the result was “stayed” until the Supreme Court could hear the case.

That case is scheduled for argument on November 10, 2020 and a decision will be rendered sometime in June of 2021.  At stake are numerous insurance protections cited above that impact millions of Americans, as well as health care coverage for 20 million people from expanded Medicaid and private insurance under the health insurance exchanges.  Despite the expected conservative majority hearing the case, there is a real chance the court will not strike down the entire ACA.  The real question before the court is whether the individual mandate can be severed from the existing law while the rest of the law survives.  This is the most likely outcome, but there are no guarantees with any case before the highest court.  NAAOP will continue to keep our members and friends informed as developments occur.

We urge all members of the O&P profession to VOTE on November 3rd!

  • Written by NAAOP