The American Orthotic & Prosthetic Association (AOPA) expects the home health final rule, published by the Centers for Medicare & Medicaid Services (CMS), to “have significant impacts on AOPA member businesses.”
In follow-up analysis on portions of the final rule impacting durable medical equipment, prosthetics, orthotics and supplies (DMEPOS), AOPA singled out “significant changes” in accreditation rules for DMEPOS providers.
“The final rule indicates that moving to an annual accreditation cycle will allow CMS to eliminate fraud and abuse by making it more difficult for unscrupulous providers and criminal entities to exploit weaknesses in the longer accreditation cycle,” the AOPA said in Dec. 3 comments. “The final rule also outlines a significant increase in CMS oversight of the policies and operations of the eight current deemed accrediting organizations. AOPA and many other organizations provided comments on the proposed provisions expressing serious concerns about the administrative and financial burden that this change would create for honest providers, especially small businesses, but CMS ultimately made no changes from the proposed provisions in the final rule.
“While the effective date of the final rule is Jan. 1, 2026, no additional information has been provided that indicates when providers and suppliers will have to begin the annual re-accreditation process. AOPA is communicating regularly with ABC (American Board for Certification in Orthotics, Prosthetics & Pedorthics) and BOC (Board of Certification/Accreditation) and will continue to provide updates as they are available.”
Competitive bidding’s impact on orthotics, prosthetics
Among the final rule’s Medicare competitive bidding policies, AOPA discussed the new remote item delivery (RID) process that will be launched for multiple product categories.
“This will include OTS [off-the-shelf] knee, OTS spinal, and OTS upper-extremity orthoses that are selected for inclusion in competitive bidding,” AOPA said. “The RID process will limit the number of contracts awarded to a handful of winning bidders who will provide items on a national basis, mostly through mail order delivery. AOPA expressed significant concern regarding the inclusion of OTS orthoses in the RID program, but CMS has indicated that they will move forward.”
AOPA added, “For OTS orthoses, bid limits many not exceed the average 2026 Medicare fee schedule amount.”
Prior authorization change
In a bit of good news, AOPA said its prior authorization request, submitted during the summer’s public comment period, was adopted by CMS.
“The final rule included a provision that will exempt Medicare providers who achieve a 90% or higher initial affirmation rate on prior authorization submissions from mandatory prior authorization for HCPCS codes included in the program,” AOPA said. “In its comments on the proposed rule AOPA suggested that providers be allowed to voluntarily continue to participate in Medicare prior authorization even if they become eligible for exemption. CMS agreed to include this as an option and memorialized it in the final rule.”
AOPA said it “will continue to provide timely and detailed analysis, guidance and resources” as the final rule’s policies roll out.
