***APTA ACTION REQUEST***
Please contact Karen Stavenjord at 800-999-2782, ext. 8508, or at
karenstavenjord@... (preferred) if you have any questions.
The Issue: The Centers for Medicare and Medicaid Services (CMS)
issued a proposed rule May 1 to implement a competitive bidding
(also known as "competitive acquisition") program for suppliers of
durable medical equipment, prosthetics, orthotics and supplies
(DMEPOS) in the Medicare program.

This rule could significantly impact the ability of physical
therapists to furnish off-the shelf orthotics, wheelchairs,
ambulatory assistive devices, and other items to their patients. We
urge you to write a letter to CMS immediately in response to this
proposal. In order for CMS to consider your letter, it must be
RECEIVED by June 30, 2006.

Background: Competitive acquisition for certain DMEPOS was mandated
by Congress in the Medicare Prescription Drug, Improvement, and
Modernization Act of 2003. Examples of items that might be
included are off-the-shelf orthotics, wheelchairs, canes, assistive
devices, and other items. Highly customized items will be excluded,
but products that require minimal adjustment and have the potential
to provide great savings to the Medicare program will be included.

As outlined below, the provisions of the May 1 proposed rule are
numerous and have far-reaching implications for physical therapists
and their patients. To learn more about the proposed rule, read the
summary on the APTA website at: http://www.apta.org/AM/Template.cfm?
Section=Durable_Medical_Equipment_DME_&CONTENTID=31345&TEMPLATE=/CM/C
ontentDisplay.cfm.

What you can do: APTA is urging physical therapists who will be
affected by this proposed rule to submit comments to CMS before the
June 30 end of the comment period.

· Identify Yourself: Begin your comments by identifying
yourself as a physical therapist and provide some background
information on your practice setting and specialty; then explain why
this issue is important to you.
· Key Point: Clearly distinguish between the work you do as
a therapist providing orthotics to your patients as an integral part
of your plan of care, and the work of commercial suppliers who sell
DMEPOS. Urge CMS to revise the proposed regulations and establish a
process that will enable physical therapists to continue to furnish
orthotics that are critical to the care of their patients.

Other Important Points To Make:
· Patient Access: The proposed competitive bidding program
poses a serious threat to timely patient access to medically
necessary DMEPOS, proposing a system that could obstruct the way
clinicians currently furnish DMEPOS to their patients. Describe
situations in which your patients would require an item to be
available to them during their visit to assist with mobility or to
stabilize an injured body part.
· PTs Routinely Make Adjustments to Orthotics: The proposed
regulations state that for orthotics to be excluded from competitive
bidding, they must be items that require more than "minimal self-
adjustment." They define items requiring more than minimum self-
adjustment as adjustments to items (e.g. bending, trimming, molding,
or assembling) that must be made by a certified orthotist. In your
comments, explain that physical therapists also perform adjustments
as a routine part of their practice, and provide clinical examples
that illustrate how and when you make adjustments to orthotics while
treating patients. Urge CMS to revise the regulations to recognize
that physical therapists perform adjustments to orthotics.
· The Importance of Specific Brands: The proposed rule does
not require winning suppliers to furnish all brands within a product
type. However, there is a provision allowing physicians to specify
certain brands if there would be an adverse medical outcome for the
patient. Explain the collaboration between physicians and physical
therapists and your role in assessing patients and specifying
certain products that address the individual needs of patients.
Urge CMS to revise the regulations to recognize the need for
physical therapists to be able to specify brands to prevent adverse
medical outcomes. The agency also asked for comments on what would
constitute an "adverse medical outcome" if a certain type of DMEPOS
could not be furnished to a particular beneficiary, so provide
information from the therapists' clinical perspective.

How to Submit Comments: Comments can be sent electronically or by
mail. To submit your comments electronically, go to:
http://www.cms.hs.gov/eRulemaking.
Be sure to indicate that you are addressing the "Proposed Rule for
Competitive Acquisition of Certain DMEPOS" in the subject line of
your e-mail. Attachments should be in Microsoft Word or WordPerfect
(Microsoft Word is preferred by CMS).
If you wish to submit comments by regular mail, enclose the original
and two copies and send them to:
Mark B. McClellan, MD, PhD
Administrator
Centers for Medicare and Medicaid Services
Department of Health and Human Services
Attention: CMS-1270-P
P.O. Box 8013
Baltimore, MD 21244-8013

Please allow sufficient time for mailed comments to arrive before
the close of business on June 30, 2006.

Send a copy of your comments to APTA. This will help the
Association reinforce the points you make. Do NOT "cc" APTA on your
comments.
· Fax a copy to Government Affairs at (703) 706-3246; or
· Email a copy to govtaffair@....
Tips: Comment letters should reflect the key points outlined above,
but they should be written in your own words – CMS is most receptive
to individualized letters.
In closing the letter, it is important that you thank the addressee
for consideration of your comments. Your letter should end with a
respectful closing salutation, such as "Sincerely."

THANK YOU FOR YOUR HELP WITH THIS IMPORTANT ISSUE.

Susan Villageliu, PT, JD
Associate Director, Reimbursement Department
American Physical Therapy Association
1111 North Fairfax Street
Alexandria, VA 22314-1488
800-999-2782, ext. 8531
703-706-8531
703-706-8519 (fax)
susanvillageliu@...