The American Orthotic and Prosthetic Association is encouraging members in Connecticut to submit comments regarding recent changes to Medicaid policies for O&P codes, according to a company statement. The changes include the elimination of some L-Codes from the fee schedule and a 10% reduction in the fee schedule for several custom orthosis Healthcare Common Procedure Coding System codes. The changes went into effect March 1.
“One proposed reimbursement change that is of particular concern is a 40% reduction in Connecticut Medicaid reimbursement for cranial remolding orthoses described by [Healthcare Common Procedure Coding System] HCPCS code S1040,” the American Orthotic and Prosthetic Association (AOPA) statement read. “The notice from Connecticut Medicaid states that the 40% reduction is to ensure consistency with reimbursement rates of other states and to contain costs.”
There are also proposed changes to the prior authorization process for cranial remolding orthoses that may lead to unnecessary and inappropriate delays in the provision of quality care, according to the statement.
CP, BOCPO, owner of Adaptive Prosthetics and Orthotics in Glastonbury, Conn., told O&P News that policy changes, such as the requirement to gain prior approval without any procedure for expedited approval, will ultimately harm patients and increase costs.
“These policy changes ultimately harm the people they claim to be representing, and it delays care and puts them in a position where they could get injured,” Hewett said. “These policies are here, and we are afraid there [are] more to come.”
Connecticut Medicaid will accept comments on these policy changes until March 30. AOPA has encouraged members to submit comments at http://aopa.freeenterpriseaction.com/lfeBx7s. The full Connecticut Medicaid announcement is available at www.aopanet.org/wp-content/uploads/2017/03/SPA17-M-Revised.pdf.
Disclosure: Hewett reports he is an employee of Adaptive Prosthetics and Orthotics.