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When it comes to a proposed rule from the Centers for Medicare and Medicaid Services (CMS) that would impose undue regulatory and financial burdens on physical therapists (PTs) who provide custom orthoses and prostheses, APTA isn't mincing any words, describing the proposed standards as a set of unnecessary requirements that will limit patient access to appropriate care.

In a March 10 letter to CMS, APTA President Sharon L. Dunn, PT, PhD, lays out the case for CMS to back away from the proposed rule, which would require PTs to be "licensed by the state [as a qualified provider of prosthetics and custom orthotics], or … certified by the American Board for Certification in Orthotics and Prosthetics … or by the Board for Orthotist/Prosthetist Certification." APTA estimates that the additional administrative and financial burdens could affect thousands of PTs across the country.

"Many physical therapists furnish and fabricate orthotics and prosthetics as appropriate," Dunn writes. "The standards that CMS is putting forth in the proposed rule are so restrictive that the effect will be to limit Medicare beneficiaries’ access to services that are safe and effective." The letter calls for CMS to maintain the provisions of a 2008 law that exempts PTs and other qualified providers from additional accreditation requirements in order to bill Medicare for the devices.

In the letter, Dunn sets out 3 main arguments against the proposed rule: namely, that PT education and training already meet requirements supposedly upheld by the proposal; that the proposed rule would wind up costing PTs significant amounts of time and money; and that naming only 2 organizations as responsible for issuing accreditations is inadequate to meet the demand for approval, should the proposal be move ahead as-is.

If enacted, Dunn writes, the real victims will be the Medicare beneficiaries themselves.

"Prohibiting physical therapists without the proposed licensure or certification from performing interventions with orthotics and prosthetics would place an undue burden on patients by forcing them to see alternative providers," Dunn writes. "This would increase the cost to the patient and the amount of time spent using health care practitioners." Further, she writes, the proposal isn't even borne out by any state-level precedent, as "no US jurisdictions prohibit physical therapists from using orthotics and prosthetics as a component of physical therapist practice."

The letter also urges CMS that should quality standards around this rule be developed in the future, the development process should be "established by consensus-based organizations that include all of the relevant providers." Although APTA was included in negotiated rulemaking around these issues in 2002, PT representatives—along with representatives of podiatrists, orthopedic surgeons, and physiatrist—have been largely excluded from quality standard development around orthotics and prosthetics.

"Developing quality standards without consulting a large number of practitioners who furnish the services is problematic and will have a significant impact on beneficiaries who receive these supplies and services," Dunn writes. "Going forward, APTA wants to ensure that all relevant parties are consulted in updating any new quality standards."

APTA is urging its members to educate themselves on the proposal, and then to provide their own comments to CMS about how the rule would hurt patient access and increase costs to PTs who are already qualified to provide custom devices. The association has created a fact sheet on the proposed rule, and offers a member-protected template letter that can be downloaded and shared with colleagues. Deadline for comments is March 13, 2017.


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