Policy Forum 2015: Building Relationships

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This year, more than 120 people attended the American Orthotic & Prosthetic Association (AOPA) 2015 Policy Forum, and they generated 696 member encounters with legislators and staff. These record-breaking numbers represented a 20 percent increase in attendance over the prior year as well as more than doubling member encounters as O&P professionals, colleagues, and patients took on Washington.

The New Jersey delegation.

The North Carolina delegation prepares for Congressional visits. Photographs courtesy of AOPA.

This year's event was held at the Renaissance Washington, DC Downtown, March 23-24. The focus was to build stronger legislative relationships through advocacy efforts. Policy Forum 2015 also marked the introduction of critical O&P legislation in the House and Senate on March 23. The Medicare Orthotics and Prosthetics Improvement Act of 2015 was introduced in the Senate by Senators Chuck Grassley (R-IA) and Mark Warner (D-VA), and in the House by Representatives Glenn Thompson (R-PA) and Mike Thompson (D-CA). The bills are known, respectively, as Senate (S.) bill 829 and House of Representatives (H.R.) bill 1530. Three of the four members of Congress have previously sponsored versions of the bills and adding Warner continues the bipartisan support this legislation has always generated, AOPA said. Also introduced into the House on March 23 was H.R. 1526, the Medicare Audit Improvement Act of 2015, sponsored by Representative Mark Meadows (R-NC).

The proposed legislation addresses audit and accreditation issues, including the following:

  • Apply existing accreditation and licensure requirements to certain prosthetics and custom-fabricated or custom-fitted orthotics n Consider orthotist's and prosthetist's clinical notes as part of the patient's medical record
  • Distinguish orthotists and prosthetists from suppliers of durable medical equipment and supplies
  • Clarify the term minimal self-adjustment for off-the-shelf (OTS) orthoses
  • Mandate that the Centers for Medicare & Medicaid Services (CMS) adheres to the statutory definition of OTS orthoses eligible for competitive bidding as only being those needing "minimal self-adjustment" by the patient, and no other person
  • Prohibit Medicare payments for prostheses and custom-fabricated orthoses unless the items are furnished by a qualified practitioner and fabricated by either a qualified practitioner or a qualified supplier
  • Require greater accountability and transparency of Recovery Audit Contractors (RAC), including publishing audit rates and appeal outcomes rates
  • Exempt services that receive prior authorization from RAC review
  • Maintain due process and satisfy the 90-day statutory period for Administrative Law Judge (ALJ) decisions
  • Limit recoupment from Medicare appellants until completion of the ALJ appeals process

The first day of Policy Forum offered attendees the chance to hear from various speakers who gave suggestions about how to approach lawmakers and their staff regarding the issues at hand. Representative Brett Guthrie (R-KY) was the keynote speaker; he discussed the importance of actively participating in the legislative process. Several other presentations and discussion panels prepared the attendees for their congressional visits scheduled for the next day. Grassley gave the opening remarks on day two; he reminded attendees that the First Amendment not only guarantees freedom of speech, but also the right to "petition for a governmental redress of grievances." He stressed the importance of lawmaker visits and the impact that they have as well as his strong belief in the O&P Medicare Improvement Act.

Afterward, participants received their schedules and headed off to meet with their legislators. In addition to requesting that their legislators sign on to the legislation mentioned herein, other talking points and sign-on requests addressed endorsing Congress' initial determination to exempt O&P from any post-acute care bundling; providing facts about O&P and competitive bidding and issues surrounding the definition of OTS orthoses; giving an overview of the O&P prepayment and post-payment audit concerns; requesting funding for short-term competitive grants to universities to launch O&P educational programs; restoring due process and ALJ hearing timeframes; and expressing concern about the revised U.S. Department of Veterans Affairs prosthetics contract template.

To access the Policy Forum material, visit www.aopanet.org/legislative-regulatory/2015-policy-forum.