US Politics: HR-5661 Qualified Practitioner Poll
Description
Collection
Title:
US Politics: HR-5661 Qualified Practitioner Poll
Text:
Dear US OANDP-L Subscribers....
The following is a simple 2 Question Poll regarding the recent controversial
US Federal Legislation (HR-5661) that identifies who are Qualified
Practitioners for providing custom designed O&P health care services. The
Poll will only require a simple YES or NO answer.
Below you will find an exact word-for-word copy of the final language of
HR-5661 SEC 427 that includes the definition(s) of a Qualified Practitioner
for providing certain O&P health care services. You can also axcess the
entire Bill at the folllowing URL:
<URL Redacted>
This is an Adobe PDF file format. You will find Section 427 on page 123.
106 CONGRESS H.R. 5661 - SECTION 427 PAGE 149 TO 155:
SEC. 427. ESTABLISHMENT OF SPECIAL PAYMENT PROVISIONS AND REQUIREMENTS FOR
PROSTHETICS AND CERTAIN CUSTOM-FABRICATED ORTHOTIC ITEMS.
(a) IN GENERAL.-Section 1834(h)(1) (42 U.S.C. 1395m(h)(1)) is amended
by adding at the end the following:
(F) SPECIAL PAYMENT RULES FOR CERTAIN PROSTHETICS AND CUSTOM-FABRICATED
ORTHOTICS.-
(i) IN GENERAL.-No payment shall be made under this subsection for an
item of custom-fabricated orthotics described in clause (ii) or for an item
of prosthetics unless such item is-
(I) furnished by a qualified practitioner; and
(II) fabricated by a qualified practitioner or a qualified
supplier at a facility that meets such criteria as the Secretary determines
appropriate.
''(ii) DESCRIPTION OF CUSTOM-FABRICATED ITEM.-
(I) IN GENERAL.-An item described in this clause is an item of
custom-fabricated orthotics that requires education, training, and experience
to custom-fabricate and that is included in a list established by the
Secretary in subclause (II). Such an item does not include shoes and shoe
inserts.
''(II) LIST OF ITEMS.-The Secretary, in consultation with
appropriate experts in orthotics (including national organizations
representing manufacturers of orthotics), shall establish and update as
appropriate a list of items to which this subparagraph applies. No item may
be included in such list unless the item is individually fabricated for the
patient over a positive model of the patient.
''(iii) QUALIFIED PRACTITIONER DEFINED.-In this subparagraph, the term
'qualified practitioner' means a physician or other individual who-
''(I) is a qualified physical therapist or a qualified
occupational therapist;
''(II) in the case of a State that provides for the licensing of
orthotics and prosthetics, is licensed in orthotics or prosthetics by the
State in which the item is supplied; or
''(III) in the case of a State that does not provide for the
licensing of orthotics and prosthetics, is specifically trained and educated
to provide or manage the provision of prosthetics and custom-designed or
-fabricated orthotics, and is certified by the American Board for
Certification in Orthotics and Prosthetics, Inc. or by the Board for
Orthotist/Prosthetist Certification, 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 such prosthetics and orthotics.
''(iv) QUALIFIED SUPPLIER DEFINED.-In this subparagraph, the term
'qualified supplier' means any entity that is accredited by the American
Board for Certification in Orthotics and Prosthetics, Inc. or by the Board
for Orthotist/Prosthetist Certification, or accredited and approved by a
program that the Secretary determines has accreditation and approval
standards that are essentially equivalent to those of such Board.''
(b) EFFECTIVE DATE.-Not later than 1 year after the date of the
enactment of this Act, the Secretary of Health and Human Services shall
promulgate revised regulations to carry out the amendment made by subsection
(a) using a negotiated rulemaking process under subchapter III of chapter 5
of title 5, United States Code.
(c) GAO STUDY AND REPORT.-
(1) STUDY.-The Comptroller General of the United States shall
conduct a study on HCFA Ruling 96-1, issued on September 1, 1996, with
respect to distinguishing orthotics from durable medical equipment under the
medicare program under title XVIII of the Social Security Act. The study
shall assess the following matters:
(A) The compliance of the Secretary of Health and Human
Services with the Administrative Procedures Act (under chapter 5 of title 5,
United States Code) in making such ruling.
(B) The potential impact of such ruling on the health care
furnished to medicare beneficiaries under the medicare program, especially
those beneficiaries with degenerative musculoskeletal conditions.
(C) The potential for fraud and abuse under the medicare
program if payment were provided for orthotics used as a component of durable
medical equipment only when made under the special payment provision for
certain prosthetics and custom-fabricated orthotics under section
1834(h)(1)(F) of the Social Security Act, as added by subsection (a) and
furnished by qualified practitioners under that section.
(D) The impact on payments under titles XVIII and XIX of
the Social Security Act if such ruling were overturned.
(2) REPORT. - Not later than 6 months after the date of the
enactment of this Act, the Comptroller General shall submit to Congress a
report on the study conducted under paragraph (1).
------------------------------------------------------------------------------
----------------
REPLIES & RESULTS OF THE POLL:
In keeping with the Posting Policies of OANDP-L, you are asked not to
re-post your response to OANDP-L, as there are over 2,000 subscribers to this
Listserver. I will post the results following a sufficient period of time
for responses to be received and tallied.
QUESTIONNAIRE INSTRUCTIONS:
It is suggested that you highlight and copy the Poll from the single line
below to the double line at the end of the poll and paste it into the body of
your reply/response.
(Important Note: NO response will be included into the final results unless
you provide your name and professional or consumer classification.)
_________________________________________________________________
POLL QUESTIONS
1. Do you feel the final language of HR-5661, SEC 427, appropriately
identifies who should be Qualified Practitioners for providing custom
designed and fabricated orthotic and/or prosthetic devices?
YES / NO
COMMENTS (Optional):
2. Would you be willing to respond to a more comprehensive Internet Poll on
this subject?
YES / NO
COMMENTS (Optional):
NAME and PROFESSIONAL CREDENTIAL or CONSUMER CLASSIFICATION
Respondent Name:
Respondent Classification(s):
Physician (Must Identify Specialty)
ABC Certified Prosthetist, ABC Certified Orthotist, ABC Certified
Orthotist/Prosthetist
BOC Orthotist, BOC Prosthetist, BOC Orthotist/Prosthetist
Pedorthotist, Occupational Therapist, Physical Therapist
Orthotic Consumer, Prosthetic Consumer
Parent of Orthotic Consumer, Parent of Prosthetic Consumer
Other (Specialty Must Be Identified)
=========================================================
Thank You for taking the time to respond to this Questionnaire!!
John N. Billock, CPO, Vice President & Legislative Committee Co-Chairman
<A HREF= <URL Redacted>>National Association for the Advancement of Orthotics & Prosthetics</A>
1875 Eye Street, N.W., 12th Floor, Washington, D.C. 20006-5409
The following is a simple 2 Question Poll regarding the recent controversial
US Federal Legislation (HR-5661) that identifies who are Qualified
Practitioners for providing custom designed O&P health care services. The
Poll will only require a simple YES or NO answer.
Below you will find an exact word-for-word copy of the final language of
HR-5661 SEC 427 that includes the definition(s) of a Qualified Practitioner
for providing certain O&P health care services. You can also axcess the
entire Bill at the folllowing URL:
<URL Redacted>
This is an Adobe PDF file format. You will find Section 427 on page 123.
106 CONGRESS H.R. 5661 - SECTION 427 PAGE 149 TO 155:
SEC. 427. ESTABLISHMENT OF SPECIAL PAYMENT PROVISIONS AND REQUIREMENTS FOR
PROSTHETICS AND CERTAIN CUSTOM-FABRICATED ORTHOTIC ITEMS.
(a) IN GENERAL.-Section 1834(h)(1) (42 U.S.C. 1395m(h)(1)) is amended
by adding at the end the following:
(F) SPECIAL PAYMENT RULES FOR CERTAIN PROSTHETICS AND CUSTOM-FABRICATED
ORTHOTICS.-
(i) IN GENERAL.-No payment shall be made under this subsection for an
item of custom-fabricated orthotics described in clause (ii) or for an item
of prosthetics unless such item is-
(I) furnished by a qualified practitioner; and
(II) fabricated by a qualified practitioner or a qualified
supplier at a facility that meets such criteria as the Secretary determines
appropriate.
''(ii) DESCRIPTION OF CUSTOM-FABRICATED ITEM.-
(I) IN GENERAL.-An item described in this clause is an item of
custom-fabricated orthotics that requires education, training, and experience
to custom-fabricate and that is included in a list established by the
Secretary in subclause (II). Such an item does not include shoes and shoe
inserts.
''(II) LIST OF ITEMS.-The Secretary, in consultation with
appropriate experts in orthotics (including national organizations
representing manufacturers of orthotics), shall establish and update as
appropriate a list of items to which this subparagraph applies. No item may
be included in such list unless the item is individually fabricated for the
patient over a positive model of the patient.
''(iii) QUALIFIED PRACTITIONER DEFINED.-In this subparagraph, the term
'qualified practitioner' means a physician or other individual who-
''(I) is a qualified physical therapist or a qualified
occupational therapist;
''(II) in the case of a State that provides for the licensing of
orthotics and prosthetics, is licensed in orthotics or prosthetics by the
State in which the item is supplied; or
''(III) in the case of a State that does not provide for the
licensing of orthotics and prosthetics, is specifically trained and educated
to provide or manage the provision of prosthetics and custom-designed or
-fabricated orthotics, and is certified by the American Board for
Certification in Orthotics and Prosthetics, Inc. or by the Board for
Orthotist/Prosthetist Certification, 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 such prosthetics and orthotics.
''(iv) QUALIFIED SUPPLIER DEFINED.-In this subparagraph, the term
'qualified supplier' means any entity that is accredited by the American
Board for Certification in Orthotics and Prosthetics, Inc. or by the Board
for Orthotist/Prosthetist Certification, or accredited and approved by a
program that the Secretary determines has accreditation and approval
standards that are essentially equivalent to those of such Board.''
(b) EFFECTIVE DATE.-Not later than 1 year after the date of the
enactment of this Act, the Secretary of Health and Human Services shall
promulgate revised regulations to carry out the amendment made by subsection
(a) using a negotiated rulemaking process under subchapter III of chapter 5
of title 5, United States Code.
(c) GAO STUDY AND REPORT.-
(1) STUDY.-The Comptroller General of the United States shall
conduct a study on HCFA Ruling 96-1, issued on September 1, 1996, with
respect to distinguishing orthotics from durable medical equipment under the
medicare program under title XVIII of the Social Security Act. The study
shall assess the following matters:
(A) The compliance of the Secretary of Health and Human
Services with the Administrative Procedures Act (under chapter 5 of title 5,
United States Code) in making such ruling.
(B) The potential impact of such ruling on the health care
furnished to medicare beneficiaries under the medicare program, especially
those beneficiaries with degenerative musculoskeletal conditions.
(C) The potential for fraud and abuse under the medicare
program if payment were provided for orthotics used as a component of durable
medical equipment only when made under the special payment provision for
certain prosthetics and custom-fabricated orthotics under section
1834(h)(1)(F) of the Social Security Act, as added by subsection (a) and
furnished by qualified practitioners under that section.
(D) The impact on payments under titles XVIII and XIX of
the Social Security Act if such ruling were overturned.
(2) REPORT. - Not later than 6 months after the date of the
enactment of this Act, the Comptroller General shall submit to Congress a
report on the study conducted under paragraph (1).
------------------------------------------------------------------------------
----------------
REPLIES & RESULTS OF THE POLL:
In keeping with the Posting Policies of OANDP-L, you are asked not to
re-post your response to OANDP-L, as there are over 2,000 subscribers to this
Listserver. I will post the results following a sufficient period of time
for responses to be received and tallied.
QUESTIONNAIRE INSTRUCTIONS:
It is suggested that you highlight and copy the Poll from the single line
below to the double line at the end of the poll and paste it into the body of
your reply/response.
(Important Note: NO response will be included into the final results unless
you provide your name and professional or consumer classification.)
_________________________________________________________________
POLL QUESTIONS
1. Do you feel the final language of HR-5661, SEC 427, appropriately
identifies who should be Qualified Practitioners for providing custom
designed and fabricated orthotic and/or prosthetic devices?
YES / NO
COMMENTS (Optional):
2. Would you be willing to respond to a more comprehensive Internet Poll on
this subject?
YES / NO
COMMENTS (Optional):
NAME and PROFESSIONAL CREDENTIAL or CONSUMER CLASSIFICATION
Respondent Name:
Respondent Classification(s):
Physician (Must Identify Specialty)
ABC Certified Prosthetist, ABC Certified Orthotist, ABC Certified
Orthotist/Prosthetist
BOC Orthotist, BOC Prosthetist, BOC Orthotist/Prosthetist
Pedorthotist, Occupational Therapist, Physical Therapist
Orthotic Consumer, Prosthetic Consumer
Parent of Orthotic Consumer, Parent of Prosthetic Consumer
Other (Specialty Must Be Identified)
=========================================================
Thank You for taking the time to respond to this Questionnaire!!
John N. Billock, CPO, Vice President & Legislative Committee Co-Chairman
<A HREF= <URL Redacted>>National Association for the Advancement of Orthotics & Prosthetics</A>
1875 Eye Street, N.W., 12th Floor, Washington, D.C. 20006-5409
Citation
“US Politics: HR-5661 Qualified Practitioner Poll,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 2, 2024, https://library.drfop.org/items/show/216000.
