OandPCARE.org > Payers & Regulators > Credentialing, Licensing & Medicare

Credentialing, Licensing & Medicare

The O&P profession currently has several credentialing and licensing scenarios that are dictated by specific state requirements and the profession itself.

State Licensure

Currently, eight states have licensure in place for O&P practitioners. Most of these were developed following the professional credentialing model established by the American Board of Certification for Orthotics and Prosthetics (ABC).

ABC administers State Licensure Exams in Florida, Washington, Texas, Ohio, Illinois, and New Jersey and has guidelines to assist in the establishment and operation of state licensure laws. These guidelines, which provide a template for licensure bills and licensure administrative rules, are available on ABC's website.

ABC serves as a resource for and provides assistance to groups and state boards undertaking efforts to seek state licensure requirements. If you have questions or need more information about developing licensure in your state, please contact Thomas Derrick, or 703-836-7114, ext. 224.

Professional Certification

In 1948, the American Board for Certification in Orthotics and Prosthetics Inc. (ABC) was formed by a group of concerned practitioners and orthopedic surgeons to set minimum standards for practitioners' education and experience levels and to test their clinical knowledge. As the first O&P certification program, ABC became the standard and is currently recognized by federal, state and private agencies for the establishment of standards for the orthotic and prosthetic profession. It is also approved by the National Commission for Certifying Agencies (NCCA).

Basic requirements for certification include: a baccalaureate degree in orthotics and prosthetics or a baccalaureate degree with a post-grad orthotics or prosthetics certificate; a one-year accredited residency; and satisfactory completion of written, written simulation and clinical patient management examinations. Over 5,000 O&P practitioners are ABC-certified. Visit the ABC website for more details on the program.

Medicare Requirements

Section 1834(h) of the Social Security Act specifies that payment for custom fabricated orthotics and prosthetics are to only be furnished by qualified providers. Effective July 1, 2005, CMS has deemed that certain specialties, licensed or certified by the State or an approved entity, are qualified to furnish prosthetics and certain custom-fabricated orthotics.

Orthotics and Prosthetics personnel are required to be certified by an accrediting organization, of which The American Board for Certification is the primary body.

As defined, qualified providers include the following specialties:

• Orthotics personnel certified by an accrediting organization
• Prosthetics personnel certified by an accrediting organization
• Pedorthists personnel certified by an accrediting organization
• Medical Supply Company with orthotics and/or prosthetic personnel certified by an accrediting organization
• Physical Therapist, independently practicing and licensed by the State
• Occupational Therapist, licensed by the State
• All Physicians*

*Specialty Codes listed in CMS Manual 100.4 Chapter 26, Section 10.8.2

Source: CMS Manual System Change Request 3607,
www.cms.hhs.gov/manuals/pm_trans/R445CP.pdf CMS Specialty List.

Facility Accreditation

ABC maintains a facility accreditation program, which sets standards for patient care services. Provider standards lead to the improvement of existing patient treatment methods as well as assisting in the development of organizational models for the establishment of new organizations and programs. ABC's facility accreditation includes a written application and on-site evaluation. It is recognized by federal, state and private agencies for the establishment of standards for the orthotic and prosthetic profession, and is also approved by the National Commission for Certifying Agencies (NCCA). Currently, there are more than 1,250 ABC-accredited facilities.

For more information on ABC Accreditation, please view the ABC Accreditation Brief . This brief provides healthcare officials with an overview of the program, distribution statistics, and a detailed look at the standards of ABC Accreditation.

OandPCARE.org > Payers & Regulators > Credentialing, Licensing & Medicare