Comment Letters

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.


UPDATE:  Custom Fabricated Orthotics Rule

The Office of Management and Budget (OMB) has posted on their website that the Centers for Medicare and Medicaid Services (CMS) proposed rule titled Establishment of Special Payment Provisions and Requirements for Qualified Practitioners and Qualified Suppliers of Prosthetics and Custom-Fabricated Orthotics (CMS-6012-P) has been withdrawn, effective August 1, 2017. NATA staff has confirmed with key Congressional staff on the committee with jurisdiction over these issues that the agency has chosen to withdraw the proposed rule.  It is unclear whether the agency will revisit this issue in future, but NATA will continue to monitor it and will provide updates when new information becomes available.

As you may recall, on January 11, 2017, the proposed rule was released by CMS and included proposed qualifications needed for practitioners to furnish and fabricate prosthetics and custom-fabricated orthotics. In response, NATA submitted a formal comment letter urging CMS to recognize the level of education, training, and skills of athletic trainers and include them within the list of practitioners qualified to furnish prosthetics and custom-fabricated orthotics for Medicare beneficiaries.

Following a 60-day period of formal comment, which closed March 13, 2017, the agency is typically expected to review the comments submitted by the public and release a final rule shortly thereafter.  However, since the proposed rule has been withdrawn there will not be a final rule released by the agency.

Read NATA's formal comment on the Custom Fabricated Orthotics Proposed rule (pdf)

CMS Custom Fabricated Orthotics Information Sheet (pdf)


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, September 2, 2014 (pdf)
BOC comment letter to CMS, September 2, 2014 (pdf)
CAATE comment letter to CMS, September 2, 2014 (pdf)
AAOE comment letter to CMS, July 28, 2014 (pdf)
AOSSM comment letter to CMS, August 19, 2014 (pdf)
AMSSM comment letter to CMS, August 29, 2014 (pdf)


Comment Letters



  • 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


Sign-On letters