There are myriad reasons individuals should consider pursuing licensure in the states where they practice orthotics and prosthetics (O&P). There are currently 13 states with O&P licensure laws. These states are:
Links to the state licensure acts and each state’s administrative rules (where they are available online) are available through the Academy’s Licensure Toolkit (Appendix 2) at http://www.oandp.org/Licensure-Toolkit.pdf
The primary reason for enacting state licensure is patient protection. Statewide requirements that include minimum standards for education, training, and testing of those seeking to provide O&P patient care help ensure that those providing this care have met certain standards before they are allowed to treat patients.
In most states even hair dressers, barbers, and nail technicians are required to be licensed. The practice of O&P requires specialized training, education, and skills, yet in states without licensure there is no regulation regarding who can provide O&P services and devices. Licensure provides an oversight for patient protection that otherwise does not exist.
Scope of Practice
It is important to have legislatively defined the scope of practice for O&P professionals. In states without O&P licensure other professions have included O&P within their scope of practice without defining the educational requirements and certification needed to guarantee patients quality care. For example, in some states where physical therapists (PT) are licensed, the PTs might have expanded their state PT practice act to include O&P services. This “legislatively” allows them to provide services and devices for which they have not received the comprehensive education, training, and certification that O&P practitioners receive. So it is crucially important for O&P professionals to have licensure with a defined scope of practice, education, and training.
Medicare Transmittal 656
In 2005 The Centers for Medicare and Medicaid Services (CMS) published Transmittal 656 which, in part, states that CMS will only pay O&P licensed providers for O&P services in states where O&P licensure has been enacted. While Transmittal 656 has not been rigorously enforced by CMS with any of its carriers, the Medicare O&P Improvements Act includes a provision to incorporate this requirement into federal statute, and independent of this bill, the O&P Alliance is working to see that enforcement of Transmittal 656 is strengthened. Obviously, if this is enforced it would have a very positive impact on those states with O&P licensure laws as it further enforces state laws by limiting who can receive reimbursement from Medicare and Medicaid for the services/devices provided by O&P practitioners. In addition, cost savings could be realized by CMS through the elimination of payment to practitioners who are unlicensed and may be unqualified to provide care or when the device provided is inappropriate.
This could also have a positive impact for beneficiaries who may be required to pay for a new device when the inappropriate device they received from an unlicensed or unqualified practitioner must be replaced. When this happens and the beneficiary has exceeded their eligibility for a new device, the cost of this new device must be borne by the patient.
Decreased Fraud and Abuse
In addition to the increase in patient protection noted above, state licensing of O&P practitioners could help limit fraud and abuse in the insurance industry. State licensing boards are an additional level for screening individuals to ensure that they are educated and certified appropriately prior to delivering or being paid for O&P services. This increased level of scrutiny should help eliminate those individuals who are operating businesses with the intent to defraud the insurance industry. Obviously, nothing is fool-proof and someone intent on committing fraud will find a way to do so, but this is another deterrent to help decrease the incidences of fraud and abuse.