Two O&P Bills in the House

WASHINGTON–Last week Rep. Shelley Berkley, D-Nev., introduced
the Medicare O&P Improvements Act of 2009 (H.R. 2479). The
legislation would assure licensure compliance, accreditation and
qualifications of orthotic and prosthetic providers who treat
Medicare patients.
 
And that, according to the American Orthotic and Prosthetic
Association, would “enhance patient care, improve health care
savings and reduce fraud.” The AOPA, which issued a statement
applauding the May 19 bill, said Sen. Ben Cardin, D-Md., has
indicated that he expects to introduce a companion version of the
bill in the Senate.  
 
“Medicare fraud and abuse are an unnecessary economic burden
on our current health care system and impede patient
treatment,” stated AOPA President Brian Gustin, CP. “By
enforcing state licensure requirements, we can help to reduce
health care costs and help the millions of Americans who need
orthotic or prosthetic care.”
 
The Medicare O&P Improvements Act aims to ensure higher quality
of care by enforcing accreditation standards enacted by Congress in
2001 and linking Medicare reimbursement to O&P provider
qualifications, the AOPA said, adding that applying
“appropriate accreditation standards for O&P
specialists” will help to reduce fraud.
 
H.R. 2479 would place “valuable credentialing requirements on
providers, better serving patients by guaranteeing the appropriate
training of the practitioners who treat them,” the group
said.
 
CMS has exempted some “eligible professionals” and
“other persons”—among them orthotists and
prosthetists—from its Sept. 30 mandatory accreditation
deadline for DMEPOS providers. But the agency has also said it will
define by rulemaking how the quality standards apply to those
groups.
 
A second bill affecting O&P called the Prosthetic and Custom
Orthotic Parity Act of 2009 (H.R. 2575) was introduced by Rep.
Robert Andrews, D-N.J., on Thursday. The bill would provide
coverage of prosthetic and custom orthotic devices, as well as
their repair and replacement, under the same terms and conditions
applicable to other medical and surgical benefits provided under
health insurance policies.
 
“At a time when health care costs are rising by about 7
percent annually, the financial hardship on those in need of
prosthetic and custom orthotic devices is devastating,”
Andrews said in his introductory remarks. “Expanding coverage
for prosthetic and custom orthotic devices so that it is on par
with other types of essential care not only will provide amputees
with proper treatment, which will allow them to experience a better
quality of life, but save our health care system money in the long
term. That is, prosthetic and orthotic devices often dramatically
decrease secondary health problems for those in need of such a
device.”

The bill was cosponsored by Reps. Lincoln Diaz-Balart, R-Fla.;
Al Green, D-Texas; George Miller, D-Calif.; Todd Platts, R-Pa.; and
Joe Sestak, D-Pa.
 
Thirteen states have already enacted O&P parity legislation.
Legislation of this type has also been introduced and is being
considered in more than 30 other states.