House committee reports bill containing O&P provisions to floor

The U.S. House of Representatives’ Ways and Means Committee voted to recommend a bill to the full House that would improve access to medically necessary O&P devices.

The bill, called the Medicare Part B Improvement Act of 2017 (H.R. 3178), is a collection of six smaller measures aimed at improving Medicare Part B programs and includes a section entitled “Orthotist’s and Prosthetist’s Clinical Notes as Part of the Patient’s Medical Record.” The measure would include clinical notes from orthotists and prosthetists, regarding the necessity of O&P devices, as part of a patient’s medical record.

The language states: “For purposes of determining the reasonableness and medical necessity of orthotics and prosthetics, documentation created by an orthotist or prosthetist shall be considered part of the patient’s medical record to support documentation created by eligible professionals described in section 1848(k)(3)(B).”

The bipartisan bill was sponsored by Reps. Kevin Brady (R-Texas), the chairman of the Ways and Means Committee, and Richard Neal (D-Mass.), its ranking member. According to Neal, the specific measure in the bill relating to O&P devices was co-sponsored by Reps. Mike Bishop (R-Mich.) and Mike Thompson (D-Calif.).

“The bill would streamline rules and make common-sense changes in order to preserve access to orthotics and prosthetics for patients in need,” Bishop said. “In particular, our initiative would allow additional information provided by prosthetists and orthotists, the trained clinical experts who evaluate and fit the beneficiary, to be considered by Medicare to support documentation of medical necessity for orthotics and prosthetics. This is extremely important.”

Under the current law, Medicare pays for O&P devices for beneficiaries who demonstrate a medical need. However, Bishop said some suppliers are experiencing delays of up to 5 years to receive payment for the devices.

“This happens simply because CMS and their contractors do not provide fair consideration of the necessary documentation,” he said. “The insufficient support bureaucrats give to these providers severely weakens the bond between orthotists and prosthetists and the beneficiary.” — by Jason Laday


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