CMS releases proposed rule on O&P qualifications

CMS has released a proposed rule that would specify the requirements and qualifications needed for O&P practitioners and suppliers who furnish and fabricate prosthetics and custom orthotics, according to a press release.

The proposed rule would also enact provisions in the Social Security Act, which “requires that no Medicare payment shall be made for an item of custom-fabricated orthotics or for an item of prosthetics unless furnished by a qualified practitioner and fabricated by a qualified practitioner or a qualified supplier at a facility that meets criteria the Secretary determines appropriate.”

CMS will accept comments on the new rule until March 13, and will respond to comments in its final rule.

In its response, the American Orthotic and Prosthetic Association (AOPA) said the new rule’s provisions “appear to be in line” with what AOPA has supported, specifically defining “qualified” providers as those accredited by the American Board for Certification in Orthotics and Prosthetics (ABC) or the Board for Orthotist/Prosthetist Certification (BOC). In addition, the AOPA said in its statement it agreed only qualified providers should be able to submit claims for prosthetics or custom-fabricated orthotics.

“That said, clearly, there are areas of the proposed regulations which will require revisions, edits and improvements, via comments to be prepared and submitted by AOPA and others in the O&P profession,” the AOPA said in its statement, in part. “Further analysis of the rule is underway.”

The proposed rule would define a qualified practitioner as someone who is “licensed by the state, or in absence of licensure requirements is certified by the [ABC] or by the [BOC], 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.”

Qualified suppliers would be DMEPOS suppliers that are also accredited by the ABC or BOC, or by an alternative program that the Secretary determines has standards equivalent to those boards.

The full fact sheet on the proposed rule can be viewed here:

“This proposal straddles two Administrations — published as a proposal at the end of the Obama Administration, to be acted upon by the new Trump Administration,” read the AOPA statement. “It will take some time before we even know the new Administration’s regulatory intentions as to O&P, and what priority they may or may not have to move this forward.”


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