May 4, 2017

NAAOP Update: ACA Repeal, O&P Issues Progress

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The National Association for the Advancement of Orthotics and Prosthetics (NAAOP) released a webcast in which NAAOP General Counsel Peter Thomas, JD, discusses the repeal of the Affordable Care Act (ACA) and the progression of O&P-related issues. A summary of the webcast follows:

ACA Repeal: Of greatest concern to moderates is how the bill will impact those with pre-existing conditions and Medicaid beneficiaries. One of the biggest concerns for NAAOP is a recent amendment to the AHCA that would allow states to opt out of providing essential health benefits (EHBs), which includes coverage for rehabilitative services and devices. This language is why the majority of ACA health plans and Medicaid expansion plans cover O&P devices. NAAOP strongly supports continued access to O&P care in any bill passed by Congress on health reform.

Editorís note: In the webcast, Thomas discusses the struggles in the U.S. House of Representatives (House) to gather enough support to repeal the ACA; however, since the webcast was released, Republicans in the House succeeded in passing the bill to repeal and replace the ACA. The measure will now advance to the U.S. Senate.

Injured and Amputee Veterans Bill of Rights: NAAOP is working to reintroduce federal legislation to help educate veterans about their rights to obtain O&P care under the U.S. Department of Veterans Affairs healthcare program. The bill seeks to make veterans aware of their right to select the practitioner of their choice and to obtain appropriate prosthetic technology that meets their needs. A new bipartisan bill is expected to be introduced soon.

Performant Audits: The nationwide Medicare Recovery Audit Contractor (RAC) for O&P claims, Performant, recently posted an approved issue on its website that signaled a new round of audits on code L-5845 (addition, endoskeletal, knee-shin system, stance flexion feature, adjustable), which is used with a variety of single axis knee L-Codes. NAAOP and its O&P Alliance partners view the approval of this audit issue as a major overreach by Performant/the Centers for Medicare & Medicaid Services (CMS) and have taken aggressive steps to oppose this issue and request withdrawal of this audit approval. The audit would change current Medicare coverage and coding guidance, which RACs do not have authority to do. Progress is being made as Performant recently removed the audit announcement from its website without explanation.

LCD Legislation: In 2015, the Durable Medical Equipment Medicare Administrative Contractors issued a draft Local Coverage Determination (LCD) for Lower Limb Prostheses that would have dramatically restricted access to the current standard of O&P care. That draft LCD was placed on hold while CMS studies the issue through an Interagency Workgroup. That debacle has contributed to the reintroduction of legislation to change the LCD process. The Local Coverage Determination Clarification Act, S. 794, was recently introduced in the Senate and aims to make the LCD process more transparent and accountable. (A House bill is under development.) The bill requires public notice and comment and other processes to improve the development of LCDs, so experiences like the draft LCD for Lower Limb Prostheses do not occur again. Special thanks to the Amputee Coalition for its leadership on this important bill. To send your two Senators an email encouraging them to cosponsor the legislation, go to the Congressional Action Center on the NAAOP website.

The webcast is posted on the NAAOP website and on, shared with members via email, and made available through the NAAOP page on Facebook.

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