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News & Press: Government Affairs News

AAOE Submits Comments on DMEPOS Competitive Bidding Proposal

Sunday, December 16, 2018   (0 Comments)
Posted by: Bradley Coffey, MA, AAOE Government Affairs
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Indianapolis, IN - The American Alliance of Orthopaedic Executives (AAOE) has submitted comments to the Centers for Medicare and Medicaid Services (CMS) regarding its proposal to move certain off-the-shelf back and knee orthotics to the Medicare Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program. In its comments, AAOE opposed the move arguing that:

  • CMS has not provided adequate information on the proposal;
  • There is still much debate surrounding CMS’ definition of off-the-shelf and its expansion of the definition of “minimal self-adjustment” versus the statutory definition;
  • The proposal rewards larger suppliers with greater economies of scale and penalizes smaller entities;
  • The proposal is unlikely to remove fraud and abuse from the Medicare program;
  • The proposal could lead to a “race to the bottom” for quality of the devices in question; and,
  • The proposal threatens to deviate from coordinated, streamlined patient care to a disjointed care delivery system that undermines patient care.

AAOE cautioned CMS that its proposal and the manner in which it was proposed threatens to undermine the care of thousands of Medicare beneficiaries, the livelihoods of thousands of clinical and support staff, and the relative transparency of the federal rulemaking process. "... CMS must understand that not only is the care of millions of Medicare beneficiaries put at risk but so are the livelihoods of thousands of Medicare providers, suppliers, and support staff. These people deserve more than a four sentence proposal and list of HCPCS codes. They deserve the full publication of the proposal in the Federal Register with a preamble and regulatory text to allow them to understand how this proposal will impact their care, business, and jobs," wrote 2018-2019 AAOE President Karen Sollar, CMPE. "Opaque public policy is counter to what we believe as Americans. We encourage future policy changes to be submitted via normal notice and comment rulemaking processes and not simply placed on a remote section of the CMS website."

CMS issued this proposal following the release of MedPAC's June 2018 report which highlighted potential fraud and abuse in the off-the-shelf orthotic space. AAOE encouraged CMS to investigate these issues and suggested that instead of moving these codes into the Competitive Bidding Program, CMS change its policies regarding face-to-face visits for orthotic prescriptions provided that exceptions were made for beneficiaries that are homebound and/or located in rural areas. The proposal also comes as CMS is retooling the DMEPOS Competitive Bidding Program. The proposal timeline allows for the competitive bidding process to likely begin in mid-year 2019 for resumption of the program in December 2020.

Joining AAOE in its comments are the BONES Society of Florida, BONES of PA, Inc., Georgia Association of Orthopaedic Executives, Midwest AAOE, South Carolina Association of Orthopaedic Executives, Texas Orthopedic Administrators Society (T-BONES), and The OrthoForum.

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