HR 1958

September 12, 2011

Press Statement
September 9, 2011                                                                                         

Contact:  Peter W. Thomas, O&P Alliance Counsel
Peter.Thomas@ppsv.com
; 202-872-6730

Washington, D.C.:  The four member organizations of the Orthotic and Prosthetic (“O&P”) Alliance, along with the Board of Certification/Accreditation, International, announced today their support for H.R. 1958, the Medicare Orthotic and Prosthetic Improvement Act of 2011, and issued a detailed rationale for that decision.  An Open Letter to the O&P community on H.R. 1958 was introduced in the 112th Congress on May 24, 2011 by Congresswoman Shelley Berkley (R-NV) and Congressman Glenn Thompson (R-PA).  It is expected to be introduced soon in the U.S. Senate.

This bipartisan legislation is designed to reduce fraud and abuse in the Medicare O&P benefit while improving the quality of care and saving the government money.  Specifically, the bill would:

  • Raise the standards for O&P accreditation organizations recognized by the Medicare program;
  • Compel CMS to fully implement billing edits that would deny payment for unlicensed O&P suppliers submitting Medicare claims in those states that have O&P licensure; and,
  • Link the right to bill Medicare for custom O&P care with satisfaction of appropriate education, training, and experience requirements.

Much of the legal framework for this bill is already in place at CMS, but this legislation would press the Centers for Medicare and Medicaid Services (CMS) to finally and fully implement regulations that would link the right of suppliers to bill the Medicare program with the complexity of O&P care provided, and the qualifications of suppliers providing that care.  As orthotic braces and prosthetic limbs are becoming more technologically advanced, there is a need for more advanced education, training and experience of those who provide these services and devices to Medicare patients.  Orthotics and prosthetics is very different from durable medical equipment (DME) in that O&P care is far more service-oriented, clinically-based, and is customized to the unique needs of every patient.  H.R. 1958 recognizes these differences between O&P and DME and seeks to implement regulations that address potential fraud and abuse in the Medicare O&P benefit through O&P-specific solutions rather than DME-based approaches.

The O&P Alliance calls on all members of the O&P community to make their representatives in Congress aware of H.R. 1958 and urge them to cosponsor this important legislation.  To access the bill, click on the following link:  H.R. 1958.