US-Politics: GAO Report Fails to Address Validity of HCFA Ruling 96-1
NAAOP
Description
Collection
Title:
US-Politics: GAO Report Fails to Address Validity of HCFA Ruling 96-1
Creator:
NAAOP
Date:
6/18/2002
Text:
GAO Report Fails to Address Validity of HCFA Ruling 96-1
Prepared by Peter W. Thomas, Esq. and Adam H. Greene, Esq.
In response to a congressional mandate, the Government Account Office
(GAO) recently issued a report assessing the impact of CMS' policy,
issued in HCFA Ruling 96-1, which categorizes as DME any orthosis that
attaches to a mobile frame, such as a wheelchair or other device. The
GAO report concludes that if HCFA Ruling 96-1 were to be rescinded, it
would lead to a modest increase in Medicare spending. The GAO also
believes that a rescission of the ruling could lead to over-
utilization, fraud, abuse, and confusion regarding the line between what
is considered DME and what is considered an orthosis.
In response to the legal challenges to HCFA Ruling 96-1 and lobbying
efforts by the O&P community, including the NAAOP, Congress included in
the Medicare, Medicaid, and SCHIP Benefits Improvement and Protection
Act of 2000 (BIPA) a provision directing the GAO to review HCFA Ruling
96-1. Specifically, BIPA required the GAO to review (a) whether CMS'
ruling complied with the APA; (b) the impact of the ruling on the health
of Medicare beneficiaries, especially those with degenerative
musculoskeletal conditions; (c) the potential for fraud and abuse if the
ruling were rescinded; and (d) the financial impact of overturning the
ruling. Based upon this congressional mandate, the GAO issued its
report in May 2002.
NAAOP representatives and many others in the O&P community met with
representatives of the GAO over the past eighteen months to discuss the
four issues mentioned in the statute. Despite this consultation, the
GAO report completely fails to address the first two statutory
requirements. The GAO's report does not question the validity of the
process used by CMS in issuing Ruling 96-1 and it makes no
recommendation regarding whether the ruling should be rescinded. It
also does not address whether the ruling is detrimental to the health of
Medicare beneficiaries. Rather, the report only outlines the potential
financial and program integrity implications were the government to
rescind the ruling. The overall tone of the report, focusing
exclusively on the negative impact of rescinding the ruling without
offering any positive consequences on patient care and resultant cost
savings, clearly does not bode well for attempts to alter this CMS'
policy and once again obtain coverage of attached orthotic bracing
systems for the growing number of beneficiaries that are residents of
nursing homes.
Visit our web site at www.oandp.com/naaop
Come share YOUR view! Government Relations is what WE do!
Prepared by Peter W. Thomas, Esq. and Adam H. Greene, Esq.
In response to a congressional mandate, the Government Account Office
(GAO) recently issued a report assessing the impact of CMS' policy,
issued in HCFA Ruling 96-1, which categorizes as DME any orthosis that
attaches to a mobile frame, such as a wheelchair or other device. The
GAO report concludes that if HCFA Ruling 96-1 were to be rescinded, it
would lead to a modest increase in Medicare spending. The GAO also
believes that a rescission of the ruling could lead to over-
utilization, fraud, abuse, and confusion regarding the line between what
is considered DME and what is considered an orthosis.
In response to the legal challenges to HCFA Ruling 96-1 and lobbying
efforts by the O&P community, including the NAAOP, Congress included in
the Medicare, Medicaid, and SCHIP Benefits Improvement and Protection
Act of 2000 (BIPA) a provision directing the GAO to review HCFA Ruling
96-1. Specifically, BIPA required the GAO to review (a) whether CMS'
ruling complied with the APA; (b) the impact of the ruling on the health
of Medicare beneficiaries, especially those with degenerative
musculoskeletal conditions; (c) the potential for fraud and abuse if the
ruling were rescinded; and (d) the financial impact of overturning the
ruling. Based upon this congressional mandate, the GAO issued its
report in May 2002.
NAAOP representatives and many others in the O&P community met with
representatives of the GAO over the past eighteen months to discuss the
four issues mentioned in the statute. Despite this consultation, the
GAO report completely fails to address the first two statutory
requirements. The GAO's report does not question the validity of the
process used by CMS in issuing Ruling 96-1 and it makes no
recommendation regarding whether the ruling should be rescinded. It
also does not address whether the ruling is detrimental to the health of
Medicare beneficiaries. Rather, the report only outlines the potential
financial and program integrity implications were the government to
rescind the ruling. The overall tone of the report, focusing
exclusively on the negative impact of rescinding the ruling without
offering any positive consequences on patient care and resultant cost
savings, clearly does not bode well for attempts to alter this CMS'
policy and once again obtain coverage of attached orthotic bracing
systems for the growing number of beneficiaries that are residents of
nursing homes.
Visit our web site at www.oandp.com/naaop
Come share YOUR view! Government Relations is what WE do!
Citation
NAAOP, “US-Politics: GAO Report Fails to Address Validity of HCFA Ruling 96-1,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 24, 2024, https://library.drfop.org/items/show/219186.
