Government Relations Update regarding CMS
NAAOP
Description
Collection
Title:
Government Relations Update regarding CMS
Creator:
NAAOP
Date:
9/5/2008
Text:
Congress and CMS Carve Huge Exemption for DME from Accreditation
Requirements and Quality Standards: New Regulations for O&P to be Proposed
Congress passed a Medicare bill in July by overriding a Presidential veto,
granting physicians a fee schedule update rather than a 10% cut in fees. The
bill also contained another provision pushed by physicians, a grant of
authority to the Secretary of Health and Human Services to exempt them and
other professionals from the accreditation requirements and quality
standards established for Durable Medical Equipment, Prosthetics, Orthotics
and Supplies (DMEPOS). CMS was given discretion to exempt these
professionals if CMS determined that the accreditation requirements and
quality standards were not specifically designed with them in mind. In other
words, if CMS determined that the standards were primarily designed for DME
and other suppliers, rather than physicians, they could be exempt.
Since the passage of this summer's Medicare bill, numerous stories in major
newspapers have highlighted the problem of fraud and abuse in the DMEPOS
benefit. CMS was recently embarrassed by revelations that they grossly
underestimated and under-reported to Congress the amount of fraud and abuse
occurring in the Medicare program. The accreditation requirements and
quality standards were intended to reduce fraud and abuse and improve the
quality of care.
However, on September 3rd, CMS held an Open Door Forum by teleconference and
announced that they essentially abandoned their discretion to make
individual interpretations for each type of professional. Instead, CMS
imposed a blanket exemption from the DMEPOS accreditation requirements and
quality standards for all physicians as well as a whole host of other
professionals, including therapists, but also including orthotists,
prosthetists, and pedorthists. This means that the quality standards
described in Appendix C that apply to the provision of orthotics,
prosthetics, and pedorthics will not apply to these practitioners going
forward. This also means that the DMEPOS quality standard and accreditation
requirements, including Appendix C, will primarily apply to DME suppliers,
pharmacies, and similar suppliers.
CMS made great efforts to state that they are currently undergoing
rulemaking to implement new provider qualification requirements for those
who provide orthotic and prosthetic care, pursuant to the Benefits
Improvement and Protection Act (BIPA) of 2001, a law that was never
implemented. CMS expects to propose these new regulations in the first half
of 2009, but with the change in Administration, this timeline is subject to
question. During the CMS conference call, CMS repeatedly acknowledged the
arguments made by the O&P field and warned participants in the call that
more O&P regulations are yet to be announced, but, unfortunately, CMS's
track record in establishing meaningful consumer protections for O&P
patients has not been impressive to date.
NAAOP will continue to make the O&P case with CMS and Congress and to work
in concert with the other O&P organizations to establish, once and for all,
appropriate quality standards and accreditation requirements for all
providers and suppliers of O&P care.
Requirements and Quality Standards: New Regulations for O&P to be Proposed
Congress passed a Medicare bill in July by overriding a Presidential veto,
granting physicians a fee schedule update rather than a 10% cut in fees. The
bill also contained another provision pushed by physicians, a grant of
authority to the Secretary of Health and Human Services to exempt them and
other professionals from the accreditation requirements and quality
standards established for Durable Medical Equipment, Prosthetics, Orthotics
and Supplies (DMEPOS). CMS was given discretion to exempt these
professionals if CMS determined that the accreditation requirements and
quality standards were not specifically designed with them in mind. In other
words, if CMS determined that the standards were primarily designed for DME
and other suppliers, rather than physicians, they could be exempt.
Since the passage of this summer's Medicare bill, numerous stories in major
newspapers have highlighted the problem of fraud and abuse in the DMEPOS
benefit. CMS was recently embarrassed by revelations that they grossly
underestimated and under-reported to Congress the amount of fraud and abuse
occurring in the Medicare program. The accreditation requirements and
quality standards were intended to reduce fraud and abuse and improve the
quality of care.
However, on September 3rd, CMS held an Open Door Forum by teleconference and
announced that they essentially abandoned their discretion to make
individual interpretations for each type of professional. Instead, CMS
imposed a blanket exemption from the DMEPOS accreditation requirements and
quality standards for all physicians as well as a whole host of other
professionals, including therapists, but also including orthotists,
prosthetists, and pedorthists. This means that the quality standards
described in Appendix C that apply to the provision of orthotics,
prosthetics, and pedorthics will not apply to these practitioners going
forward. This also means that the DMEPOS quality standard and accreditation
requirements, including Appendix C, will primarily apply to DME suppliers,
pharmacies, and similar suppliers.
CMS made great efforts to state that they are currently undergoing
rulemaking to implement new provider qualification requirements for those
who provide orthotic and prosthetic care, pursuant to the Benefits
Improvement and Protection Act (BIPA) of 2001, a law that was never
implemented. CMS expects to propose these new regulations in the first half
of 2009, but with the change in Administration, this timeline is subject to
question. During the CMS conference call, CMS repeatedly acknowledged the
arguments made by the O&P field and warned participants in the call that
more O&P regulations are yet to be announced, but, unfortunately, CMS's
track record in establishing meaningful consumer protections for O&P
patients has not been impressive to date.
NAAOP will continue to make the O&P case with CMS and Congress and to work
in concert with the other O&P organizations to establish, once and for all,
appropriate quality standards and accreditation requirements for all
providers and suppliers of O&P care.
Citation
NAAOP, “Government Relations Update regarding CMS,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 22, 2024, https://library.drfop.org/items/show/229488.
