Re: Senate Bill 1451 Sec 20

Re: Senate Bill 1451 Sec 20

Robert VanHook

8/2/1999

This message is submitted by Ronney Snell, CPO, President of AOPA:

I've tried to stay out of this, but everyone needs to know that the Harkin
Bill is a direct result of AOPA's work for the past two years work and an
investment of close to $300,000. I respectfully ask you to contact AOPA
before you send the wrong message to the wrong person. Mr. Greene had
nothing to do with the effort to restrict payments for custom Lcode to
qualified providers. We do need grassroots support, but AOPA is the proper
clearinghouse. If we are going to be successful, with this and other
similar projects, we have to use an orderly process. So, in the interest
of our profession, whether you are a member of AOPA or not, please feel
free to use the AOPA staff as your source of contact and coordination.

Sincerely,

Ronney

On Monday, August 02, 1999 11:23 AM, Ken Greene
[SMTP: <Email Address Redacted> ] wrote:
> To O&P List Serv:
>
> Here is Sec. 20 of the Harkin bill as it relates to the O&P industry.
Please read and review. We are working on a letter (we will make it
available to the listserv in the next few days) that could be sent to all
US Senators asking them to co-sponsor and/ or support S.1451
>
> Medicare Waste Tax Reduction Act of 1999 (Introduced in the Senate)
>
>
------------------------------------------------------------------------
--------
>
>
>
> SEC. 20. STANDARDS REGARDING PAYMENT FOR CERTAIN ORTHOTICS AND
PROSTHETICS.
>
> (a) STANDARDS-
>
> (1) IN GENERAL- Section 1834(h)(1) of the Social Security Act (42
U.S.C. 1395m(h)(1)) is amended by adding at the end the following:
>
> `(F) ESTABLISHMENT OF STANDARDS FOR CERTAIN ITEMS-
>
> `(i) IN GENERAL- No payment shall be made for an applicable item
unless such item is provided by a qualified practitioner or a qualified
supplier under the system established by the Secretary under clause (iii).
For purposes of the preceding sentence, if a qualified practitioner or a
qualified supplier contracts with an entity to provide an applicable item,
then no payment shall be made for such item unless the entity is also a
qualified supplier.
>
> `(ii) DEFINITIONS- In this subparagraph--
>
> `(I) APPLICABLE ITEM- The term `applicable item' means
orthotics and prosthetics that require education, training, and experience
to custom fabricate such item. Such term does not include shoes and shoe
inserts.
>
> `(II) QUALIFIED PRACTITIONER- The term `qualified practitioner'
means a physician or health professional who--
> `(aa) is specifically trained and educated to provide or manage the
provision of custom-designed, fabricated, modified, and fitted orthotics
and prosthetics, and is either certified by the American Board for
Certification in Orthotics and Prosthetics, Inc., or is credentialed and
approved by a program that the Secretary determines, in consultation with
appropriate experts in orthotics and prosthetics, has training and
education standards that are necessary to provide applicable items;
>
> `(bb) is licensed in orthotics or prosthetics by the State in which the
applicable item is supplied; or
>
> `(cc) has completed at least 10 years practice in the provision of
applicable items.
>
>
> `(III) QUALIFIED SUPPLIER- The term `qualified supplier' means
any entity that is--
> `(aa) accredited by the American Board for Certification in Orthotics and
Prosthetics, Inc.; or
>
> `(bb) accredited and approved by a program that the Secretary determines
has accreditation and approval standards that are essentially equivalent to
those of such Board.
>
>
> `(iii) SYSTEM- The Secretary, in consultation with appropriate
experts in orthotics and prosthetics, shall establish a system under which
the Secretary shall--
>
> `(I) determine which items are applicable items and formulate a
list of such items;
>
> `(II) review the applicable items billed under the coding
system established under this title; and
>
> `(III) limit payment for applicable items pursuant to clause
(i).'.
>
> (2) EFFECTIVE DATE- The amendment made by paragraph (1) shall apply
to items provided on or after January 1, 2000.
>
> (b) REVISION OF DEFINITION OF ORTHOTICS-
>
> (1) IN GENERAL- Section 1861(s)(9) of the Social Security Act (42
U.S.C. 1395x(s)(9)) is amended by inserting `(including such braces that
are used in conjunction with, or as components of, other medical or
non-medical equipment when provided by a qualified practitioner (as defined
in subclause (II) of section 1834(h)(1)(F))) or a qualified supplier (as
defined in subclause (III) of such section)' after `braces'.
>
> (2) EFFECTIVE DATE- The amendment made by paragraph (1) shall apply
to items provided on or after January 1, 2000.
> << File: ATT00034.html >>