This Just In
Note-Worthy O&P Legislation House of Representatives approves legislation legitimizing orthotists’ and prosthetists’ notes
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N JULY 25, the full House of
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SEPTEMBER 2017 | O&P ALMANAC
1 SEC. 103. Orthotist’s and Prosthetist’s Clinical Notes as Part of the Patient’s Medical Record. Section 1834(h) of the Social Security Act (42 U.S.C. 1395m(h)) is amended by adding at the end the following new paragraph:
“(5) DOCUMENTATION CREATED BY ORTHOTISTS AND PROSTHETISTS. 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 individual’s medical record to support documentation created by eligible professionals described in Section 1848(k)(3)(B).”
Advocating for the clinician’s notes to be recognized as part of the medical record has been a top priority for AOPA since the 2011 Sens. Charles Grassley “Dear Physicians” (R-Iowa) letter. This provision also has been included in the Medicare O&P Improvement Act, a bill that has been introduced every year since 2011 but never passed. Most recently, the Medicare O&P Improvement Act of 2017 was introduced in the 115th Congress earlier this summer as Senate Bill S. 1191 by Sens. Charles Grassley (R-Iowa) and Mark Warner (D-Virginia) and as House of Representatives Bill H.R. 2599 by Reps. Glenn Thompson (R-Pennsylvania) and Mike Thompson (D-California). Several members of Congress were instrumental in advancing the O&P notes provision in H.R. 3178, including Brady, Thompson, and Thompson; as well as Mike Bishop (R-Michigan), a member of the Ways & Means Committee; and Richard Neal (D-Massachusetts), the ranking minority member of the Ways & Means Committee. H.R. 3178 now moves on to the Senate, where S. 1191—the GrassleyWarner bill, supported by Sens. Bill Cassidy (R-Louisiana) and Tammy Duckworth (D-Illinois)—will hopefully move forward to favorable action.
PHOTO: Getty Images/BrianAJackson
Representatives acted by consent on suspension to adopt H.R. 3178, the Medicare Part B Improvement Act of 2017. The bill, sponsored by Kevin Brady (R-Texas), the House Ways & Means Committee chairman, would cut red tape and make some noncontroversial changes to the Medicare program by amending Title VIII of the Social Security Act “to improve the delivery of home infusion therapy and dialysis as well as the application of the Stark Rule under the Medicare Program,” according to the official record. Included in this bill was a single provision on orthotics and prosthetics—the long-awaited provision to recognize the orthotist’s/prosthetist’s notes as part of the medical record in Medicare Medical Necessity Determinations. Such recognition acknowledges that many amputee
and orthotic patients may not see the referring physician when they have issues or questions about their devices, and the bond between the patient and the O&P health professionals may be the major factor in regaining mobility and quality of life, according to AOPA. Follow-up care is one of the factors that distinguishes O&P care from wheelchairs and other durable medical equipment. This step would likely reduce unfavorable Recovery Audit Contractor audits and return the O&P provider notes to the status they previously enjoyed prior to the inception of the current CMS audit policy. Following is the specific text from H.R. 3178 as enacted by the House: