Seventh Floor, 1501 M Street, NW, Washington, DC 20005, Phone: (202) NAAOP Legislative Webinar October 26, 2011 Peter W. Thomas, J.D., NAAOP General Counsel O&P Alliance Counsel Powers Pyles Sutter & Verville, PC (202)

Seventh Floor, 1501 M Street, NW, Washington, DC 20005, Phone: (202) Overview Affordable Care Act – O&P Perspectives Affordable Care Act – O&P Perspectives Key O&P Provisions impacting consumers and providers; Key O&P Provisions impacting consumers and providers; 32 million newly insured. 32 million newly insured. Essential Health Benefits Package. Essential Health Benefits Package. Is O&P Care Included in EHB? Is O&P Care Included in EHB? Federal Subsidies & Medicaid Expansion. Federal Subsidies & Medicaid Expansion. Insurance Market Protections for Consumers. Insurance Market Protections for Consumers. 2

Seventh Floor, 1501 M Street, NW, Washington, DC 20005, Phone: (202) BIPA – Sec. 427 Sec Establishment of special payment provisions and requirements for prosthetics and certain custom fabricated orthotics. Links Medicare payment with provider qualifications. Links Medicare payment with provider qualifications. Qualified practitioners include: Qualified practitioners include: Physicians; Physicians; Qualified Physical Therapists; Qualified Physical Therapists; Qualified Occupational Therapists; Qualified Occupational Therapists; O&P Licensed practitioners; O&P Licensed practitioners; O&P Accredited Practitioners & Suppliers. O&P Accredited Practitioners & Suppliers. 3

Seventh Floor, 1501 M Street, NW, Washington, DC 20005, Phone: (202) BIPA – Sec. 427 Sec Progeny. Failed negotiated rulemaking Failed negotiated rulemaking Sec. 302 – MMA – Medicare Prescription Drug, Improvement and Modernization Act of Sec. 302 – MMA – Medicare Prescription Drug, Improvement and Modernization Act of Creation of DMEPOS Supplier Competitive Bidding Program. Creation of DMEPOS Supplier Competitive Bidding Program. Includes Accreditation Requirement for DMEPOS Suppliers. Includes Accreditation Requirement for DMEPOS Suppliers. MIPPA exemption for “professionals,” including orthotists and prosthetists MIPPA exemption for “professionals,” including orthotists and prosthetists Transmittal 656 (2005). Transmittal 656 (2005) regulation codifies Transmittal regulation codifies Transmittal 656. CMS continues to refrain from fully implementing of Sec CMS continues to refrain from fully implementing of Sec Conclusion: Medicare O&P Improvement Act, HR Conclusion: Medicare O&P Improvement Act, HR

Seventh Floor, 1501 M Street, NW, Washington, DC 20005, Phone: (202) H.R Medicare O&P Improvement Act Bill Provisions: Enforces O&P Licensure. Enforces O&P Licensure. Refines O&P Accreditation. Refines O&P Accreditation. Links Payment with Provider Qualifications. Links Payment with Provider Qualifications. Codifies “Tripartite” document and references Transmittal 656 Codifies “Tripartite” document and references Transmittal 656 5

Seventh Floor, 1501 M Street, NW, Washington, DC 20005, Phone: (202) H.R Medicare O&P Improvement Act Addresses longstanding complications from PTs and OTs. Addresses longstanding complications from PTs and OTs. Ensures savings for federal government by locking in specific target. Ensures savings for federal government by locking in specific target. Clarifies that bill does not delay or eliminate CMS’ ability to competitive bid off-the-shelf orthotics or change the payment basis for O&P L-codes. Clarifies that bill does not delay or eliminate CMS’ ability to competitive bid off-the-shelf orthotics or change the payment basis for O&P L-codes. 6

Seventh Floor, 1501 M Street, NW, Washington, DC 20005, Phone: (202) S. 773 Insurance Fairness for Amputees Act Bill Provisions: Fully/Self-Insured plans that cover O&P care must do so on par with medical and surgical benefits. Fully/Self-Insured plans that cover O&P care must do so on par with medical and surgical benefits. Result: No arbitrary limits or exclusions. Result: No arbitrary limits or exclusions. Impact of Essential Benefits Package, state insurance mandates, and S Impact of Essential Benefits Package, state insurance mandates, and S

Seventh Floor, 1501 M Street, NW, Washington, DC 20005, Phone: (202) H.R. 805 – Injured and Amputee Veterans Bill of Rights Bill Provisions: Creates set of “rights” that injured and amputee vets can use to obtain appropriate O&P care. Creates set of “rights” that injured and amputee vets can use to obtain appropriate O&P care. Right to access appropriate technology. Right to access appropriate technology. Right to practitioner of one’s choice. Right to practitioner of one’s choice. Right to second opinion re prosthetic options. Right to second opinion re prosthetic options. HR 805 requires postage of rights in all O&P VA clinics and on VA website to ensure full disclosure. HR 805 requires postage of rights in all O&P VA clinics and on VA website to ensure full disclosure. 8

Seventh Floor, 1501 M Street, NW, Washington, DC 20005, Phone: (202) Questions & Answers 9