State By State

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Each month, State by State features news from O&P professionals about the most important state and local issues affecting their businesses and the patients they serve. This section includes information about medical policy updates, fee schedule adjustments, state association announcements, and more.

Update on Reimbursement for Cranial Orthoses In a clear policy win for O&P, BlueCross BlueShield has issued a revised policy, DME 103.007, “Adjustable Cranial Orthoses for Positional Plagiocephaly and Craniosynostoses,” effective March 1, 2020, in five states: Illinois, Montana, New Mexico, Oklahoma, and Texas. The updated policy addresses many of the concerns AOPA expressed in its policy review request submitted following the Nov. 1, 2019, published policy. Visit the AOPA Co-OP for additional information.

Prior Authorization for Prostheses Initial implementation of prior authorization for six prosthetic codes is scheduled for May 2020 in Pennsylvania, Michigan, Texas, and California, with nationwide implementation scheduled for late 2020. The six codes that will require Medicare prior authorization are L5856, L5857, L5858, L5973, L5980, and 5987. The selected codes represent three microprocessor-controlled prosthetic knees, a microprocessor-controlled prosthetic foot, and two functional Level 3 prosthetic feet. (See Reimbursement Page on page 18 for details on the planned rollout of prior authorization.)

Minnesota In Minnesota, Senate counsel and MN Medicaid/DHS are working on a bill to broaden the scope of prescribers of O&P to Medicaid recipients to match Medicare standards. Specifically, the bill will seek to include physician assistants, nurse practitioners, and clinical nurse specialists.

Ohio The Ohio Occupational Therapy, Physical Therapy, and Athletic Trainers Board is seeking comments and feedback on rules implementing recently enacted changes to Ohio law that allow the Occupational Therapy, Physical Therapy, and Athletic Trainers Board to grant the authority to an individual who is not licensed to practice prosthetics to engage in the 3D printing of open-source prosthetic kits. Visit the Ohio page on the AOPA Co-OP for details.

Submit Your State News To submit an update for publication in the State by State department of O&P Almanac, email awhite@AOPAnet.org. For up-to-date information about what’s happening in O&P in your state, visit the AOPA website.

Grow your customer base and introduce new products at the country’s oldest and largest meeting for the orthotic, prosthetic, and pedorthic professions in North America.

WHY EXHIBIT? • Build your customer base and increase sales by meeting with decision-makers. • Get face-to-face time with existing customers to answer questions and build new relationships. • Enjoy sponsored networking opportunities, including the opening welcome reception and closing patient demonstration event in the exhibit hall. • Increase your exposure through a wide variety of advertising and sponsorship opportunities • Speak to AOPA reimbursement experts who can answer all your O&P coding, reimbursement and compliance questions. • Much more!

EXHIBITOR BENEFITS • Two exhibitor full conference badges (per 10x10 exhibit space) which includes admission to all education sessions, CE credits, meeting materials, and welcome reception. • Additional discounted full conference badges. • Ability to receive CE credits. • FREE breakfast and lunch during show hours. • Private lounge exclusive to exhibitors.

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Want to take advantage of an exhibit and/or sponsorship opportunity? Contact Kelly O’Neill at 571/431-0852 or kelly.oneill@AOPAnet.org.

OUR COMMITMENT To advance the standard of care. To provide you with leading medical technology backed by 100 years of experience. To create better access for prosthetic and orthotic devices that change lives. And provide the education and training needed to ensure your successful outcomes. Because when your patients succeed, we have all reached our goals.

We all move forward, together.