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Threats to the Certified Orthotic Fitter Scope of Practice

April 8, 2015

Please check this page often for updates. Below is a copy of the April 8, 2015 communication we sent to our constituents regarding threats to the COF’s scope of practice. Included in this letter are links and references to a chronology of past events, a summary of our recent actions, a glossary of terms that may be unfamiliar, and suggestions for Certified Orthotic Fitters to consider. 

Note: This letter is primarily directed to our Certified Orthotic Fitters. However, since the topics discussed affect the entire O&P community, we are sending this to all BOC constituents — our certificants, accredited facilities, and approved education providers.
Thank you for your interest and support.
 

To All BOC Constituents:

Last August, we reached out to you when CMS issued a proposed rule which, if approved, would have limited CMS reimbursement for much of the care Certified Orthotic Fitters (COFs) provide. A summary of the proposed rule and additional information on it can be found below on this page. As part of our promise to keep you informed, this letter updates you on the current state of this developing situation. A brief glossary of potentially unfamiliar terms can be accessed at www.bocusa.org/glossary and a chronology of events from December 18, 2013 to April 8, 2015 can be found at this link.

Actions BOC is taking:

At this time, we are exhausting all administrative and regulatory options available to us, and providing information to key CMS officials about the unintended negative consequences that would follow if COFs are not able to provide the care they have been safely and cost-effectively providing for many years. Among the arguments we are putting forth are the following: 

  • As accrediting organizations, BOC and ABC have been empowered by CMS to determine which certified personnel are qualified to perform these adjustments; our judgment in this regard should continue to be respected and supported, as it has been in the past.
  • The function/basis of proposed rulemaking was to get comment, and CMS did not move forward at the agency level after receiving comments.
  • Even if DME MACs had the authority to make that change, we don’t believe the change was fair. Contractors are being allowed to issue interpretive decisions without involvement from CMS or input from stakeholders.

Options for Certified Orthotic Fitters to consider:

There are steps COFs can take to minimize the negative impacts in the event that we begin to see “prefabricated, custom-fitted” claims denied on the basis of a COF not being an “individual with specialized training.”

  1. The practice of “privileging” may be an option to consider. Privileging is a process by which practitioners accepted by Medicare designate others with demonstrated competence to conduct certain tasks on their behalf. This is a possible route to continue offering the full range of prefabricated/custom-fitted products you have offered in the past, and we have requested clarification from the DME MACs about this. If you choose the privileging option, you would need to connect with an accepted practitioner in your geographic area. To locate a nearby BOC-certified Orthotist, BOC’s directory– found at go.bocusa.org— is a great place to start.
  2. Similarly, you could develop a relationship with one of the practitioners specified under the Quality Standards as having specialized training and have them supervise and sign off on your work.
  3. Another opportunity is to become a BOC-certified Mastectomy Fitter or Pedorthist. Although mastectomy fitters and pedorthists cannot bill for prefabricated, custom-fitted orthotics, these two certifications each features a unique scope of practice that would allow you to provide different products and services. For more information on these certifications, please visit the Certification page of BOC’s website at www.bocusa.org/certification.
  4. You could also add new DMEPOS products to your offerings. For example, DME items would expand the products and services you provide. Please see our category list, www.bocusa.org/CategoryList, to determine if adding any of these products is right for you.
  5. On Friday April 3, we sent you an email about a letter to the Secretary of Health and Human Services (HHS), created by AOPA for members of Congress to sign. The letter asks, among other things, that CMS remedy some of these problems surrounding “minimal self-adjustment.” Having many signers to this letter could force HHS to explain to members of Congress why they have cut so many regulatory corners. If you have not already done so, please urge your Congressman or Congresswoman to add their support to that of their colleagues. Visit this link on AOPA’s website today and let your voice be heard!

Our promise to support the profession and keep you informed:

We continue to believe that the orthotic fitter certification is a valuable credential and that Certified Orthotic Fitters fulfill an important role in the provision of high-quality orthotic care. Please know that we will continue our efforts in working diligently in support of you, our constituents, and the public you serve. We will keep you advised as we receive additional information.

Again, many thanks for staying engaged. We invite you to forward this message to your colleagues and others who may be affected by this development, and to reach out to BOC’s Regulatory & Legislative Analyst, Zack Chait, at zack.chait@bocusa.org with any questions or comments about this situation. 

Best regards,

James L. Hewlett, BOCO
Chair, Board of Directors
Board of Certification/Accreditation (BOC)

November 5, 2014

CMS issued a proposed rule that could dramatically limit the care that can be provided by Certified Orthotic Fitters (COFs). BOC submitted a comment to CMS in August 2014 and provided an update below. Additionally, BOC added a Frequently Asked Questions page that specifically addresses a few questions about the proposed rule, and a timeline of what has transpired between March 27, 2014 and October 31, 2014.

To All BOC Constituents:

In August, we reached out regarding a proposed rule issued by CMS that could dramatically limit the care provided by Certified Orthotic Fitters (COFs). (Please refer to the August 21, 2014 letter below for details.) Thank you for your interest and for the many comments submitted to CMS by members of the BOC family.

This past Friday, the final rule was issued. (See pages 129-130 of the PDF.) Interestingly, the rule covers many other topics, but as far as COFs, it indicates, “…we have decided not to finalize any changes to the definition of minimal self-adjustment in §414.402 to recognize as an individual with specialized training. We may address this provision in future rulemaking.”

Like you, we find this difficult to interpret. DME MAC (Durable Medical Equipment Medicare Administrative Contractor) policy and related LCDs (Local Coverage Determinations) have already implemented the proposed rules, but there are still no supporting regulations. If any of you are having claims denied based on these unfounded policies, we’d like to know. Please send this information to BOC’s Legislative and Regulatory Specialist, Zack Chait, at zack.chait@bocusa.org.

What comes next? First, along with our O&P Alliance* colleagues, we will be asking CMS for clarification. Please know that we will continue our efforts in working diligently in support of you, our constituents, and we will keep you posted.

Again, many thanks for staying engaged.

*The members of the O&P Alliance are BOC, ABC, AOPA, the Academy, and NAAOP. For more information see: www.oandpalliance.org.

August 21, 2014

To All BOC Constituents:

CMS has issued a proposed rule that will dramatically limit the care that can be provided by Certified Orthotic Fitters (COFs). The proposed rule, “CMS-1614-P: Medicare Program; End-Stage Renal Disease Prospective Payment System, Quality Incentive Program, and Durable Medical Equipment, Prosthetics, Orthotics, and Supplies,” can be read in its entirety at this link. In Section VIII on page 40297 (pdf page 91) you will see that in the current proposed rule COFs are essentially cut off from providing care to Medicare patients.

Clearly, there is grave concern with this proposed rule, and BOC will be submitting comments to CMS about a number of them, both from BOC alone and along with the other major O&P organizations in a joint comment from the O&P Alliance. Click here to read the Alliance’s comment.

The rules state that Orthotics: custom-fitted prefabricated (OR02) may be dispensed and billed only by “individuals with specialized training,” which the rule defines as Orthotists, Physical Therapists, Occupational Therapists, Advanced-Practice Nurses, and Physicians.  COFs are not included in this list. One way to address this omission is to point out to CMS that it has already given the authority to establish the requirements for provision of prefabricated orthoses (OR02) to its deemed accreditation organizations (including BOC).

We urge you to submit a comment to CMS by September 2, 2014, and strongly oppose this aspect of proposed rule CMS-1614-P. You can send your comment to:

Marilyn Tavenner, Administrator
Centers for Medicare and Medicaid Services
U.S. Department of Health and Human Services
Attention:  CMS-1614-P
P.O. Box 8010
Baltimore, MD 21244-8010

Or we have provided a pre-written message that you can easily customize and submit. The text that appears in red should be deleted and replaced with your own words. Feel free to personalize or modify any other sections, as well. Then, submit your comment online at this link.

Thank you in advance for taking action. If you have any questions or if we may be of additional assistance, please email wendy.miller@bocusa.org.