April 2005 • Vol. 1, No. 1
	Advancing Orthotic and Prosthetic Care Through Knowledge

NAAOP Government Relations Update

(A new feature from the National Association for the Advancement of Orthotics & Prosthetics on topical government relations issues for the benefit of AAOP/NAAOP members.)

O&P professionals should prepare for a busy year in Congress. With a major budget fight over the fiscal future of Medicare and Medicaid, the 109th Congress promises to be a contentious and partisan tug of war that may impact O&P care, reimbursement, and, ultimately, patients and people with disabilities. As a result of the election, the Senate Republicans gained four seats to achieve a 55-44-1 majority; the House of Representatives also added three Republican seats and now stands at 232-201-1, thus increasing the likelihood of partisan-driven reform.

Competitive Bidding of DME and "Off-the-Shelf" Orthotics

The Program Advisory and Oversight Committee (PAOC) for competitive bidding of Durable Medical Equipment, some orthotics, and suppliers held a meeting December 7–8, 2004 and met February 28–March 2, 2005. The committee has been charged with advising Centers for Medicare & Medicaid Services (CMS) on the development of the competitive bidding program mandated by the Medicare Modernization Act of 2003.

Although not specifically addressed by the committee during discussions, there appears to be consideration of inclusion of some spinal and lower limb orthoses in the competitive bidding system. No specific codes were outlined, nor was there consideration of how broad the scope of "off-the-shelf orthotics" should be set. Clearly there are many unanswered questions with respect to how professional orthotic care will be impacted by the implementation process.

Topics for discussion at the next meeting will include the methodology for setting payments, the bid solicitation process, small supplier issues and data collection, accreditation organizations, supplier standards, criteria for evaluating suppliers, and financial standards.

MedPAC Study on Physical Therapist Direct Access Casts Doubt on Viability of Proposal

The Medicare Payment Advisory Commission (MedPAC) released a highly anticipated report on December 31, 2004, that casts into doubt the possibility that Congress could authorize Medicare beneficiaries' access to physical therapists without first having to obtain a prescription from a physician.

The Medicare Modernization Act of 2003 required that MedPAC conduct a study—within one year of enactment—on the feasibility and advisability of allowing "direct access" to outpatient physical therapy. MedPAC considered the issue publicly at its December 2004 meeting and "tipped its hat" slightly indicating that elimination of the physician referral and review requirements would set a bad precedent for other Medicare services. The formal recommendation came in late December in a written report, which also cited this reason for not endorsing direct access.

This report, ultimately, is good news for the O&P field. Because the physical therapists have made progress in the states in expanding their scope of practice to include O&P services, the elimination of the physician referral requirement at the federal level may have had the effect of permitting PTs to self-prescribe and then provide O&P care. This could have conceivably cut out O&P providers from treating large numbers of Medicare and other patients. The MedPAC report was a significant blow to the PTs’ strategy and, in this respect, represents a significant victory for the O&P field.

Written by Peter W. Thomas, Esq., NAAOP General Counsel and Dustin W.C. May, Legislative Director, Powers, Pyles, Sutter & Verville, P.C.