Representatives Glenn Thompson (R-PA) and Shelley Berkley (D-NV) have introduced HR 1958, the Medicare Orthotics and Prosthetics Improvement Act of 2011.  The Medicare Orthotics and Prosthetics Improvement Act seeks to improve patient care and reduce fraud in Medicare by requiring CMS to enforce an existing policy, created in BIPA in 2000, that Medicare apply accreditation and licensure standards for O&P providers. The legislation would also create a revised payment system for O&P services that links practitioner qualifications with the type of care and level of complexity of the device being provided to the patient.  An independent study commissioned by AOPA found that the Medicare Orthotics and Prosthetics Improvement Act would save an estimated $250 million over 5 years by eliminating fraud and abuse.

“Fraud and abuse contributes not only to rising costs, but it also harms patients, particularly when medically necessary devices are provided without expert care or without necessity, we need to collectively look to create savings by combating waste, fraud, and abuse. This legislation will enhance patient care and ensure that Medicare fraud is addressed, particularly when the fiscal solvency of the program is in question.”  –Congressman Glenn Thompson (Gant Daily, 5/24/11)

Recently passed legislation exempted nearly all providers and suppliers from accreditation standards until the Secretary of HHS determines which standards apply. This leaves patients vulnerable to substandard care and a Medicare system subject to fraud and abuse. H.R. 1958 will ensure qualified orthotics and prosthetics professionals provide better, more efficient patient care and reduce unnecessary spending by both Medicare and seniors.

OPGA President Dennis Clark voiced his support for HR 1958 today by saying, “This important piece of legislation is a high priority of the orthotics and prosthetics industry.  Ensuring properly credentialed, qualified practitioners will create better patient outcomes and strengthen us as a profession.”

OPGA Government Relations urges our members to contact their Congressperson and ask them to support HR 1958, the Medicare Orthotics and Prosthetics Improvement Act.  Please Contact OPGA for help contacting your federal representatives, or click the link below.

Contact your local congressperson

 AOPA made headlines last week by lobbying the Treasury Department and the IRS for an exemption for O&P related products from the medical device excise tax.  The Affordable Care Act allows for products that are retail in nature to be excluded from the tax.  AOPA made a very convincing case for an exemption of all O&P products. AOPA also commissioned a study that concludes nearly 75% of private insurance packages include O&P coverage.  This should help O&P’s efforts to be included in the “essential benefits package” being debated at HHS.  The EBP is a minimum set of benefits that must be included in any insurance plan sold on the “health exchanges”, which will ramp up in 2014.  It is very important that O&P be included in the essential benefits package.  Check out the OPGA Connection for more information on the essential benefits package.

 Last week brought more health care hearings to Capitol Hill.  Several Governors testified on the stresses of Medicaid on state budgets this year and the need for waivers to be granted by CMS on eligibility and mandatory benefits.  Governor Haley Barbour (R-MS) raised the possibility of turning Medicaid into a “block grant” program, meaning the Federal government would give each state a lump sum annually for Medicaid expenditures and leave implementation of the program completely up to individual states.  Obviously, this depends heavily on individual state policies, but this proposal would likely to have a negative impact on the coverage of O&P under Medicaid, as well as the number of patients eligible for Medicaid nationwide.  On a related note, the President did endorse a bill that would allow states to “opt out” of Affordable Care Act requirements, but only if they presented a plan to meet benchmarks outlined in the bill for coverage, benefits and cost containment.

 OPGA Government Relations will continue to monitor these issues; you can follow these updates daily on our Government Effects blog, www.opga.com.  Please contact us if you have any questions, comments or ideas.