AOTA Advocacy Succeeds in Regulations Affecting DMEPOS Suppliers
Occupational therapists who supply orthotics or other medical supplies to patients should carefully follow the impending changes under Medicare Part B, which will soon impose additional requirements to bill these items as a "supplier." AOTA has been working vigorously on these new rules and succeeded in preventing restrictions limiting occupational therapy practice from being included in the final rules and regulations.
The Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA) required the Centers for Medicare & Medicaid Services (CMS) to implement industry guidance to ensure that suppliers of durable medical equipment, orthotics, prosthetics, and supplies (DMEPOS) are reviewed and accredited under specific quality standards. In addition, the MMA mandated a new DMEPOS payment system, which is commonly referred to as "competitive bidding."
Regulatory changes affecting DMEPOS suppliers, including occupational therapists that bill for orthotics, are being issued by CMS under various types of policy documents, each of which has a separate comment period and effective date. AOTA has been analyzing and providing feedback to CMS on each issue. Below are summaries of each of these regulations.
Under Competitive Acquisition, also known as competitive bidding, competitive bids would be submitted by DMEPOS suppliers to establish the payment amounts for particular DMEPOS items. CMS proposes that the Medicare payment amounts would be set at the median of the winning suppliers' bids for selected items. Competitive bidding does not apply to every DMEPOS item; for example, suppliers of off-the-shelf orthotics must competitively bid to bill under Medicare, but suppliers of custom-fabricated orthotics need not go through competitive bidding to bill Medicare. AOTA commented on the proposed rule and is awaiting the final rule on competitive bidding, which is expected to be issued on or around October 1, 2006.
As stated above, the MMA required CMS to implement an accreditation process to ensure that suppliers of DMEPOS are reviewed under specific quality standards. On August 2, 2006, CMS issued a final rule responding to stakeholder comments related to the DMEPOS accreditation process. According to this final rule, all DMEPOS suppliers, including occupational therapists, must obtain accreditation from a CMS-approved accreditation organization. The accreditation organizations CMS chooses will be responsible for applying the quality standards to all DMEPOS suppliers. AOTA, along with physicians and other groups, has strenuously argued that being a recognized professional under Medicare should be viewed as a "proxy" for the accreditation and that accreditation should be required only of non-professional suppliers. CMS has said that current law does not allow for this exception. Thus, occupational therapists, physical therapists, and physicians will be accredited.
Draft quality standards were issued by CMS in September 2005. AOTA had many meetings and conversations with CMS staff to assert that state licensure and completion of an occupational therapy accredited education program are sufficient to meet the accreditation standards, and that the application of separate quality standards to occupational therapists would be unnecessary. AOTA worked closely with the American Society of Hand Therapists (ASHT) in defending this position. AOTA submitted comments on the draft quality standards in November 2005. The final quality standards were issued on August 15, 2006, and as of the writing of this article, our comments are still being reviewed. CMS will be applying quality standards to suppliers of orthotics, prosthetics, manual wheelchairs and power mobility devices (including complex rehab and assistive technology devices).
Effect of the Accreditation Rule on Occupational Therapists
According to the accreditation rule released on August 2, 2006, occupational therapists, physicians, physical therapists, and others who supply DMEPOS will have to be accredited by an accreditation organization in order to bill Part B of the Medicare program for DMEPOS. This means that in order to bill either custom-fabricated or pre-fabricated orthotics [Level II HCPCS codes] to Medicare, occupational therapists must have a separate accreditation as a supplier. This rule does not affect an occupational therapist's ability to provide treatment such as orthotics management and bill using CPT codes, but affects the "supplying" of devices.
CMS stated that they want to minimize burden and duplication of efforts for suppliers that have already been accredited, Medicare-certified, and/or licensed under state law. Accordingly, accreditation organizations will consider any previous accreditation, certification, and/or licensure that are relevant to meeting DMEPOS quality standards. AOTA will continue to work to assure that licensed therapists who supply orthotics will be given special considerations as professionals and not be required to fulfill all the burdens of accreditation required of other non-licensed DMEPOS suppliers.
AOTA's Ongoing Efforts
None of the current areas of DMEPOS regulation are now required of occupational therapists who supply DMEPOS. Even after competitive bidding becomes effective, the bidding program will be phased in throughout the country over the next 3 years, beginning with 10 of the largest metropolitan statistical areas in 2007. However, AOTA encourages occupational therapists who intend to continue to bill Medicare Part B for Level II HCPCS codes to review the accreditation rule and final quality standards and prepare for the implementation of these rules. AOTA will continue to fight to assure that the accreditation, quality standards, and competitive bidding processes protect occupational therapists' right to supply orthotics.
Read the full text of the final rule on accreditation requirements at http://www.cms.hhs.gov/inpatientrehabfacpps/ downloads/cms_1540f.pdf.
Read the final quality standards at http://www.cms.hhs.gov/CompetitiveAcqforDMEPOS/downloads/ CMS_DMEPOS_Quality_Standards_081406.pdf.