Views From AOPA Leadership

Contact Has Been Made, Communication Is Occurring

GIVEN THE EVER-MORE CHALLENGING regulatory, legislative, and economic environments the O&P profession faces, wins sometimes feel few and far between. When they do happen, it’s important to acknowledge and celebrate them. I want to call out an important victory that AOPA helped achieve that will positively affect O&P facilities, manufacturers, and the patients we serve. The win involves the final standards for Medicare prior authorization of orthoses that patients require on an urgent basis.

In January, CMS announced the expansion of the Medicare prior authorization program to include five codes describing certain knee orthoses and spinal orthoses— L0648, L0650, L1832, L1833, and L1851. AOPA’s conversations with members revealed significant concerns about how to adequately treat patients who cannot wait for authorization before receiving their orthosis due to an emergent clinical need. AOPA therefore initiated outreach to the durable medical equipment Medicare administrative contractors (DME MACs) and high-level CMS officials, described the issue to them, and suggested potential solutions that would grant Medicare beneficiaries appropriate device access while also ensuring adequate protection of Medicare funds.

This outreach paid off when, on April 12, CMS issued guidance consistent with AOPA’s recommendations. The final regulation stated that if the existing two-day expedited review process would delay care and risk the health or life of the beneficiary, the Medicare prior authorization requirement will be suspended. This protects patients by permitting immediate delivery of emergent-need orthoses without a prior authorization determination. And it protects the Medicare trust fund by making those claims subject to 100% prepayment review.

This was just the latest in a regular series of interactions between AOPA Director of Coding and Reimbursement Services, Education, and Programming Joe McTernan and CMS/the DME MACs. McTernan’s focus on regular, proactive engagement with CMS and its contractors validates AOPA’s 2022 Strategic Plan, which includes as key priorities 1) increasing access to clinically appropriate, evidence-based care and 2) driving collaboration by creating strategic relationships. This work can be thankless—it involves a real investment of time and effort, often without discernable results. But thanks to the positive relationships AOPA has fostered with these entities and their willingness, in turn, to collaborate with us, we were able to create a solution far better than the original version.

We will continue to invest in our strategic priorities, especially our relationships with influencers of O&P policy. Our goal is to be able to consistently serve as a stakeholder in these discussions—either because CMS reaches out to us affirmatively, or because our outreach to them yields a call-back because they see us as having a valuable perspective worthy of consideration. Ideally, we hope to shape and influence policy before it is finalized.

The “urgent need” prior authorization issue for certain orthoses is an example of how this approach can pay off. And this is just the first of what we hope will be many positive results of AOPA’s investment of time, energy, and resources into relationships with the influencers of O&P policy.

Let us also reassure you that while we celebrate our wins, that doesn’t mean that we stop pushing and advocating on your behalf regarding those issues. We are always looking for the next opportunity, the next win, because more is always needed. We will continue to relentlessly advocate for this profession moving forward. We’re excited about the outcome regarding this issue. And we’re committed to delivering even more value to you throughout the remainder of 2022 and beyond.

Specialists in delivering superior treatments and outcomes to patients with limb loss and limb difference.

Board of Directors

OFFICERS

President Dave McGill Össur Americas, Foothill Ranch, CA

President-Elect Teri Kuffel, JD Arise Orthotics & Prosthetics, Spring Lake Park, MN

Vice President Mitchell Dobson, CPO Hanger, Austin, TX

Immediate Past President Traci Dralle, CFm Fillauer Companies, Chattanooga, TN

Treasurer Rick Riley O&P Boost, Bakersfield, CA

Executive Director/Secretary Eve Lee, MBA, CAE AOPA, Alexandria, VA

DIRECTORS

Jeffrey M. Brandt, CPO Ottobock, Exton, PA

Elizabeth Ginzel, MHA, CPO Össur, Fort Worth, TX

Kimberly Hanson, CPRH Ottobock, Austin, TX

John “Mo” Kenney, CPO, FAAOP Kenney Orthopedics, Lexington, KY

Jim Kingsley Hanger Clinic, Oakbrook Terrace, IL

Linda Wise WillowWood, Mount Sterling, OH

Shane Wurdeman, MSPO, PhD, CP, FAAOP(D) Research Chair, Hanger Clinic, Houston Medical Center, Houston, TX

James O. Young Jr., CP, LP, FAAOP Amputee Prosthetic Clinic, Tifton, GA