Proposed Payment Changes for Orthotics and Prosthetics

Posted by ASHT Practice Division on 01/23/2017

CMS published a new proposed rule that could severely limit the ability of hand therapists to be paid for custom-fabricated orthoses. Rule CMS-6012-P “Establishment of Special Payment Provisions and Requirements for Qualified Practitioners and Qualified Suppliers of Prosthetics and Custom Fabricated Orthotics,” published in the Federal Register January 12, 2017, removes exemptions to quality standards and orthotic certification for OTs and PTs, and would require licensure in orthosis fabrication by the state or the American Board for Certification in Orthotics and Prosthetics or the Board for Orthotist/Prosthetist Certification or a program “approved by the HHS Secretary.” Suppliers who do not meet the standard will not receive payment for custom-fabricated orthoses, and may face revocation of both their Medicare and DMEPOS eligibility. ASHT, in conjunction with HTCC, APTA’s Hand Academy and AOTA, are drafting comments on the proposed rule and will update members as more information is revealed.

Learn more from CMS

How you can help: Review your state practice acts to determine if orthosis fabrication is included in your scope of practice. Please contact ASHT if your practice act does not specify orthosis fabrication.

ASHT President Gary Solomon discusses Rule CMS-6012-P in a new video on the ASHT Facebook page

Comments

Comment: 
(E) Assessment, design, fabrication, application, fitting, and training in assistive technology, adaptive devices, and orthotic devices, and training in the use of prosthetic devices. However, this does not include the following: (i) Gait training. (ii) Training in the use of hearing aids, tracheoesophageal valves, speaking valves, or electrolarynx devices related to the oral production of language. (iii) Remediation of speech, language, and hearing disorders. (iv) Fabrication of shoe inserts. Respectfully submitted by Heidi Hermann Wright, DHS, MBA, OTR, CHT

Comment: 
The Arkansas Occupational Therapy Practice Act states, "Specific occupational therapy techniques include, but are not limited to instruction in activities of daily living, design, fabrication , application, recommendation and instruction in the use of selected orthotic or prosthetic devices and other adaptive equipment."

Comment: 
Reference: http://ncbot.org/Downloads/practice%20act%20and%20rules/NCBOT%20Rules.pdf It describes Occupational Therapy Services (under section .0103 Definitions) as: 15c. Interventions and procedures to promote or enhance safety and performance in activities of daily living (ADL), instrumental activities of daily living (IADL), education, work, play, leisure and social participation, including: (i) Therapeutic use of occupations, exercises, and activities; (ii) Training in self-care, self-management, home management, and community/work reintegration; (iii) Development, remediation, or compensation of physical, cognitive, neuromuscular, sensory functions and behavioral skills; (iv) Therapeutic use of self, including one's personality, insights, perceptions, and judgments, as part of the therapeutic process; (v) Education and training of individuals, including family members, caregivers, and others; (vi) Care coordination, case management, and transition services; (vii) Consultative services to groups, programs, organizations, or communities; (viii) Modification of home, work school or community environments and adaptation of processes, including the application of ergonomic principles; (ix) Assessment, design, fabrication, application, fitting, and training in assistive technology, adaptive devices, and orthotic devices, and training in the use of prosthetic devices; (x) Assessment, recommendation, and training in techniques to enhance functional mobility, including wheelchair management; (xi) Driver rehabilitation and community mobility; (xii) Management of feeding, eating, and swallowing to enable eating and feeding performance; and (xiii) Application of physical agent modalities, and use of a range of specific therapeutic procedures to enhance performance skills.

Comment: 
(IX) Assessment, design, fabrication, application, fitting, and training in assistive technology and adaptive and orthotic devices and training in the use of prosthetic devices, excluding glasses, contact lenses, or other prescriptive devices to correct vision unless prescribed by an optometrist;

Comment: 
The Pennsylvania State Occupational Therapy practice act does include orthotic fabrication. The following is from the Act: (3) The design, fabrication and application of [splints] orthotics to enhance performance in occupations,

Comment: 
"Practice of physical therapy" means that branch of the healing arts that is concerned with, upon medical referral and direction, the evaluation, testing, treatment, reeducation and rehabilitation by physical, mechanical or electronic measures and procedures of individuals who, because of trauma, disease or birth defect, present physical and emotional disorders. The practice of physical therapy also includes the administration, interpretation, documentation, and evaluation of tests and measurements of bodily functions and structures within the scope of practice of the physical therapist. However, the practice of physical therapy does not include the medical diagnosis of disease or injury, the use of Roentgen rays and radium for diagnostic or therapeutic purposes or the use of electricity for shock therapy and surgical purposes including cauterization.

Comment: 
Taken from the MI practice act (Sec. 18301) : (G) Assessment, design, fabrication, application, fitting, and training in rehabilitative and assistive technology, adaptive devices, and low temperature orthotic devices, and training in the use of prosthetic devices. For the purposes of this sub-subparagraph, the design and fabrication of low temperature orthotic devices does not include permanent orthotics.

Comment: 
SUBCHAPTER 5. SCOPE OF PRACTICE 13:44K-5.1 SCOPE OF PRACTICE OF A LICENSED OCCUPATIONAL THERAPIST : 5) The design, fabrication, application and/or selection of adaptive equipment, prosthetics and/or orthotic devices, except dental devices;

Comment: 
(k) “Practice of occupational therapy” means the therapeutic use of purposeful and meaningful goal-directed activities (occupations) which engage the individual’s body and mind in meaningful, organized, and self-directed actions that maximize independence, prevent or minimize disability, and maintain health. Occupational therapy services encompass occupational therapy assessment, treatment, education of, and consultation with, individuals who have been referred for occupational therapy services subsequent to diagnosis of disease or disorder (or who are receiving occupational therapy services as part of an Individualized Education Plan (IEP) pursuant to the federal Individuals with Disabilities Education Act (IDEA)). Occupational therapy assessment identifies performance abilities and limitations that are necessary for self-maintenance, learning, work, and other similar meaningful activities. Occupational therapy treatment is focused on developing, improving, or restoring functional daily living skills, compensating for and preventing dysfunction, or minimizing disability. Occupational therapy techniques that are used for treatment involve teaching activities of daily living (excluding speech-language skills); designing or fabricating selective temporary orthotic devices, and applying or training in the use of assistive technology or orthotic and prosthetic devices (excluding gait training). Occupational therapy consultation provides expert advice to enhance function and quality of life. Consultation or treatment may involve modification of tasks or environments to allow an individual to achieve maximum independence. Services are provided individually, in groups, or through social groups.

Comment: 
"Occupational therapy", the use of purposeful activity or interventions designed to achieve functional outcomes which promote health, prevent injury or disability and which develop, improve, sustain or restore the highest possible level of independence of any individual who has an injury, illness, cognitive impairment, psychosocial dysfunction, mental illness, developmental or learning disability, physical disability or other disorder or condition. It shall include assessment by means of skill observation or evaluation through the administration and interpretation of standardized or nonstandardized tests and measurements. Occupational therapy services include, but are not limited to: (a) The assessment and provision of treatment in consultation with the individual, family or other appropriate persons; (b) Interventions directed toward developing, improving, sustaining or restoring daily living skills, including self-care skills and activities that involve interactions with others and the environment, work readiness or work performance, play skills or leisure capacities or enhancing educational performances skills; (c) Developing, improving, sustaining or restoring sensorimotor, oral-motor, perceptual or neuromuscular functioning; or emotional, motivational, cognitive or psychosocial components of performance; and (d) Education of the individual, family or other appropriate persons in carrying out appropriate interventions. Such services may encompass assessment of need and the design, development, adaptation, application or training in the use of assistive technology devices; the design, fabrication or application of rehabilitative technology such as selected orthotic devices, training in the use of orthotic or prosthetic devices; the application of ergonomic principles; the adaptation of environments and processes to enhance functional performance; or the promotion of health and wellness;