January/ February 2019 State by State

The latest news from Arkansas, California,
Georgia, Indiana, and Vermont


AOPA members have reported that a private payor is denying authorization unless the O&P provider lowers the patient’s K level. The reported negotiation tactic is arbitrary and unsupported by any medical claim that the patient’s reported level is incorrect. Providers in Arkansas are concerned about the risk this poses to their patients with respect to being able to access appropriate prosthetic technology and care.


The California Orthotic and Prosthetic Association (COPA) has partnered with a health-care economist who has extensive knowledge of the Medi-Cal program to prepare an economic analysis. COPA plans to include the analysis in a legislative proposal to address California’s stagnant Medi-Cal fee schedule.


O&P providers in the state of Georgia had until Dec. 31, 2018, to either apply for a license as a durable medical equipment provider under the Pharmacy Board, or file a written attestation documenting the reason for exemption. Individuals already licensed to practice in Georgia were exempt, but facilities still had to file attestations for each location that was billing Medicaid, according to the Georgia Society of Orthotists and Prosthetists. AOPA will be posting a poll on the Georgia page of the Co-OP to gather information about the ramifications of this change and the effects seen by providers in the state.


AOPA held a conference call for its members in Indiana to open a dialogue for O&P providers to discuss the possibility of introducing licensure legislation in the state. There is no formal effort underway, as this was just an opportunity for individuals to express their concerns. AOPA state reps Curt Bertram, CPO, FAAOP, and Tim Ruth, CPO, plan to continue efforts to organize providers in Indiana around the question of licensure and to address some of the other issues facing O&P
in the state.


In December, AOPA posted an update regarding a Blue Cross Blue Shield Vermont announcement that the Adjustable Cranial Orthoses for Postitional Plagiocephaly and Craniosynostoses Medical Policy had been reviewed and updated, effective Jan. 1, 2019. If you are an O&P provider in Vermont, you should have received a network bulletin and/or notice about the policy changes. Please let us know by emailing co-op@aopanet.org if you have seen the policy language and have any concerns.


The next AOPA State Reps call will be held on Friday, February 8, at 12:00 noon. The AOPA State Reps network meets quarterly to discuss issues facing AOPA members at the state and local levels.