Section 1 Short title
This Act may be cited as the “Medicare Orthotics and Prosthetics Patient-Centered Care Act”.
Medicare Orthotics and Prosthetics Patient-Centered Care Act
A BILL
To amend title XVIII of the Social Security Act to protect beneficiaries with limb loss and other orthopedic conditions by providing access to appropriate, safe, effective, patient-centered orthotic and prosthetic care; to reduce fraud, waste, and abuse with respect to orthotics and prosthetics, and for other purposes.
Sec. 2 Increasing protections for Medicare beneficiaries receiving orthotic and prosthetic care
Prohibition on payment for items delivered by drop shipment—
In general— Section 1834(h)(1) of the Social Security Act (42 U.S.C. 1395m(h)(1)) is amended by adding at the end the following new subparagraph:
“(I) Prohibition on payment for certain items furnished using a drop shipment
“(i) In general—No payment shall be made under this subsection for an item described in clause (ii) furnished to an individual via a drop shipment.
“(ii) Items described—This items described in this clause are the following:
“(I) A prosthesis (as defined in paragraph (4)(C)), except that such term does not include supplies for such prosthesis.
“(II) A custom-fabricated orthosis (as described in subparagraph (F)(ii)), or a custom-fitted orthosis, except that such term does not include supplies for such orthosis.
“(III) Off-the-shelf orthotics (as defined in section 1847(a)(2)(C)) that are not otherwise subject to competitive bidding and are delivered by drop shipment.
“(iii) Drop shipment defined—In this subparagraph, the term drop shipment means the direct shipment of a prosthesis or an orthosis to an individual that has not received training or education with respect to fitting and adjustment or training in the care and use of such prosthesis or orthosis from a qualified practitioner (as described in subparagraph (F)(iii)).”
Effective date— The amendment made by paragraph (1) shall apply to items furnished on or after the first day of the first full calendar year following the date of enactment of this Act.
Additional practitioners exempt from competitive acquisition— Section 1847(a)(7)(A)(i) of the Social Security Act (42 U.S.C. 1395w–3(a)(7)(A)(i)) is amended—
by inserting “, physical therapist, occupational therapist, orthotist, prosthetist” after “by a physician”; and
by inserting “, physical therapist, occupational therapist, orthotist, prosthetist” after “the physician’s” in each place such term occurs.
Ensuring beneficiary access to replacement custom-Fitted orthotic devices and custom-Fabricated orthotic devices— Section 1834(h)(1)(G) of the Social Security Act (42 U.S.C. 1395m(h)(1)(G)) is amended—
in the heading, by inserting “, custom-fitted orthotic devices, custom-fabricated orthotic devices,” after “Replacement of prosthetic devices”; and
in clause (i), by inserting “, replacement of custom-fitted orthotic devices, replacement of custom-fabricated orthotic devices,” after “which are artificial limbs,”.
Updating definitions of orthotics and prosthetics— Section 1834(h)(4)(C) of the Social Security Act (42 U.S.C. 1395m(h)(4)(C)) is amended by striking “the term orthotics and prosthetics has the meaning given such term”, and inserting “the terms orthotics and prosthetics and orthoses and prostheses have the meaning given such terms”.
Regulations— Not later than 1 year after the date of the enactment of this Act, the Secretary of Health and Human Services shall promulgate final regulations to implement the amendments made by this Act.