CMS Announces Proposed Rule on O&P Qualified Providers


This morning, CMS released a proposed rule that would enact the long awaited provisions of Section 1834(h) of the Social Security Act, which “requires that no Medicare payment shall be made for an item of custom-fabricated orthotics or for an item of prosthetics unless furnished by a qualified practitioner and fabricated by a qualified practitioner or a qualified supplier at a facility that meets criteria the Secretary determines appropriate. The statute also establishes requirements for both qualified suppliers and qualified practitioners. The proposed rule would implement these provisions.” Read the full press release from CMS.

Based on the press release, in the most general and preliminary terms, these provisions appear to be in line with what AOPA has supported with the Medicare O&P Improvements Act in defining qualified providers as those accredited with ABC or BOC and that only qualified providers can submit claims for prosthetics or custom-fabricated orthotics. That said, clearly, there are areas of the proposed regulations which will require revisions, edits and improvements, via comments to be prepared and submitted by AOPA and others in the O&P profession. Further analysis of the rule is underway.

This proposal straddles two Administrations – published as a proposal at the end of the Obama Administration, to be acted upon by the new Trump Administration. It will take some time before we even know the new Administration’s regulatory intentions as to O&P, and what priority they may or may not have to move this forward.

CMS will accept comments on the proposed rule over a 60 day period from the time the proposed rule appears in the Federal Registrar- with a deadline of March 13, 2017 and will respond to comments in a final rule. AOPA is currently analyzing the rule and will provide a more detailed summary once it becomes available.