Regulatory Comment Letters and Guidance

NATA often comments on proposed rules and regulations that may affect the athletic training profession.  If you would like to view the comments please contact the Government Affairs Department.

NATA's Response to CMS Proposal Defining Health Professionals Who Can Self-Adjust Orthotics

NATA President Jim Thornton formed a task force made up of NATA members and other experts in the area of orthotics to work with NATA staff to respond to this issue. The task force and NATA staff collected data and information to respond directly to each of the items CMS proposed as part of their rationale for the rule change. The task force and staff worked together to draft a formal comment letter from NATA to CMS making the argument that athletic trainers are more than qualified to perform these services.

NATA reached out to physician organizations, health professional groups, manufacturers, smaller employers of athletic trainers, and individual physician practices that were willing to collaborate in reaching out to CMS and Capitol Hill.

It is important to note that NATA did not seek a full grassroots effort from the membership because this is a regulatory/rulemaking issue and not a legislative issue that would benefit from members on the Hill hearing from their constituents.

However, NATA staff and industry partners did pursue a targeted Hill strategy. They met with key Members of Congress on the Senate Finance Committee and House Ways and Means Committees. NATA received support from a Member of Congress who is a medical professional with experience working with athletic trainers who agreed to lead an effort to secure a Congressional sign-on letter to CMS in support of including athletic trainers as a health profession with “specialized training.”


Overview of the Issue

On July 2, 2014 the Centers for Medicare and Medicaid Services (CMS) released a proposed rule for public comment that has serious consequences for athletic trainers if enacted as written. NATA quickly formed a task force to fully research the issue and provide a comprehensive strategy for response. The proposed rule relates to the coverage and payment of durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS). Specifically, the rule updates the definition of minimal self-adjustment of orthotics by defining those health professionals that have “specialized training” needed to provide custom fitting services if providers are not certified orthotists.

This rule, if it were to go into effect, would exclude athletic trainers from the ability to perform services that are clearly part of their education, training, and clinical experience. Obviously, these services are a core element of the role and history of athletic trainers.

We firmly believe that athletic trainers meet these same requirements and should not be excluded from performing services that are directly related to their clinical expertise, education, training, and experience.

NATA comment letter to CMS
BOC comment letter to CMS
CAATE comment letter to CMS
AAOE comment letter to CMS
AOSSM comment letter to CMS
AMSSM comment letter to CMS


Comment Letters

  • Comment Letter: Medicare Program; Revisions to Payment Policies under the Physician Fee Schedule, Clinical Laboratory Fee Schedule & Other Revisions to Part B for CY 2014; CMS-1600-P, 78 Fed. Reg. 43282 (July 19, 2013)
  • Comment Letter: Incentives for Nondiscriminatory Wellness Programs in Group Health Plans RIN 1210-AB55; REG-122707-12; CMS-9979-P77 Fed. Reg. 70619 (Jan. 25, 2013)
  • Comment Letter:  Medicare Program Revisions to Payment Policies Under the Physician Fee Schedule, DME Face to Face Encounters, Elimination of the Requirement for Termination of Non-Random Prepayment Complex Medical Review and Other Revisions to Part B for CY 2013 77 Fed. Reg. 44722 (July 30, 2012)
  • Medicare and Medicaid Programs; Electronic Health Record Incentive Program – Stage 2 [CMS-0044-P]; RIN 0938-AQ84 (May 3, 2012)
  • Comment Letter: Essential Health Benefits Bulletin of December 16, 2011(Jan. 31, 2012)
  • Comment Letter:Medicare and Medicaid Program; Regulatory Provisions to Promote Program Efficiency, Transparency, and Burden Reduction (Dec.23, 2011)
  • Comment Letter: Intensive Behavioral Therapy for Obesity (Sept. 30, 2011)
  • Comment Letter:Reducing Regulatory Burden; Retrospective Review Under Executive Order 13563 (June 30, 2011)
  • Comment Letter: Medicare Program; Medicare Shared Savings Program: Accountable Care Organizations [CMS–1345–P] (June 6, 2011)
  • Comment Letter:Medicare Program; Request for Information Regarding Accountable Care Organizations and the Medicare Shared Saving Program [CMS-1345-NC] (Dec. 3, 2010)
  • Comment Letter: Medicaid Program; Comments on Legislative Changes to Provide Quality of Care to Children, CMS-2480-NC (Aug. 30, 2010)
  • Comment Letter: Medicare Program; Payment Policies Under the Physician Fee Schedule and Other Revisions to Part B for CY 2011 (CMS-1503-P) (Aug. 24, 2010)
  • Comment Letter: Request for Comments on DHHS Draft Strategic Plan FY 2010-2015 (Aug. 13, 2010)
  • Comment Letter: 2010 SOC Guidelines (July 21, 2008)



  • Guidance: ACA Non-discrimination in health care provision, July 2013
  • Guidance: Health System-based Health Insurers, July 2013
  • Guidance: Health Care Reform Update for Employee Benefit Plans: What the Delay of the Employer Mandate Means for Plan Sponsors, July 2013
  • Guidance: Final Wellness Program Rules: New Requirements Will Likely Require Changes to Outcome-based Programs, June 2013
  • Guidance: Negotiating ACO Participation Agreements, December 2012



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