II 

113TH CONGRESS 

1ST SESSION S. 1318 

To amend title XIX of the Social Security Act to cover physician services 

delivered by podiatric physicians to ensure access by Medicaid beneficiaries to appropriate quality foot and ankle care, to amend title XVIII 

of such Act to modify the requirements for diabetic shoes to be included 

under Medicare, and for other purposes. 

IN THE SENATE OF THE UNITED STATES 

JULY 18, 2013 

Mr. SCHUMER (for himself and Mr. GRASSLEY) introduced the following bill; 

which was read twice and referred to the Committee on Finance 

A BILL 

To amend title XIX of the Social Security Act to cover 

physician services delivered by podiatric physicians to 

ensure access by Medicaid beneficiaries to appropriate 

quality foot and ankle care, to amend title XVIII of 

such Act to modify the requirements for diabetic shoes 

to be included under Medicare, and for other purposes. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Helping Ensure Life5 and Limb-Saving Access to Podiatric Physicians Act’’ or 

6 the ‘‘HELLPP Act’’. 


jbell on DSK7SPTVN1PROD with BILLS
2 

•S 1318 IS

1 SEC. 2. INCLUDING PODIATRISTS AS PHYSICIANS UNDER 

2 THE MEDICAID PROGRAM. 

3 (a) IN GENERAL.—Section 1905(a)(5)(A) of the So4 cial Security Act (42 U.S.C. 1396d(a)(5)(A)) is amended 

5 by striking ‘‘section 1861(r)(1)’’ and inserting ‘‘para6 graphs (1) and (3) of section 1861(r)’’. 

7 (b) EFFECTIVE DATE.— 

8 (1) IN GENERAL.—Except as provided in para9 graph (2), the amendment made by subsection (a) 

10 shall apply to services furnished on or after January 

11 1, 2014. 

12 (2) EXTENSION OF EFFECTIVE DATE FOR

13 STATE LAW AMENDMENT.—In the case of a State 

14 plan under title XIX of the Social Security Act (42 

15 U.S.C. 1396 et seq.) which the Secretary of Health 

16 and Human Services determines requires State legis17 lation in order for the plan to meet the additional 

18 requirement imposed by the amendment made by 

19 subsection (a), the State plan shall not be regarded 

20 as failing to comply with the requirements of such 

21 title solely on the basis of its failure to meet these 

22 additional requirements before the first day of the 

23 first calendar quarter beginning after the close of 

24 the first regular session of the State legislature that 

25 begins after the date of enactment of this Act. For 

26 purposes of the previous sentence, in the case of a 


jbell on DSK7SPTVN1PROD with BILLS
3 

•S 1318 IS

1 State that has a 2-year legislative session, each year 

2 of the session is considered to be a separate regular 

3 session of the State legislature. 

4 SEC. 3. MODIFICATIONS TO REQUIREMENTS FOR DIABETIC 

5 SHOES TO BE INCLUDED UNDER MEDICAL 

6 AND OTHER HEALTH SERVICES UNDER MEDI7 CARE. 

8 (a) IN GENERAL.—Section 1861(s)(12) of the Social 

9 Security Act (42 U.S.C. 1395x(s)(12)) is amended to read 

10 as follows: 

11 ‘‘(12) subject to section 4072(e) of the Omni12 bus Budget Reconciliation Act of 1987, extra-depth 

13 shoes with inserts or custom molded shoes (in this 

14 paragraph referred to as ‘therapeutic shoes’) with 

15 inserts for an individual with diabetes, if— 

16 ‘‘(A) the physician who is managing the in17 dividual’s diabetic condition— 

18 ‘‘(i) documents that the individual has 

19 diabetes; 

20 ‘‘(ii) certifies that the individual is 

21 under a comprehensive plan of care related 

22 to the individual’s diabetic condition; and 

23 ‘‘(iii) documents agreement with the 

24 prescribing podiatrist or other qualified 

25 physician (as established by the Secretary) 


jbell on DSK7SPTVN1PROD with BILLS
4 

•S 1318 IS

1 that it is medically necessary for the indi2 vidual to have such extra-depth shoes with 

3 inserts of custom molded shoes with in4 serts; 

5 ‘‘(B) the therapeutic shoes are prescribed 

6 by a podiatrist or other qualified physician (as 

7 established by the Secretary) who— 

8 ‘‘(i) examines the individual and de9 termines the medical necessity for the indi10 vidual to receive the therapeutic shoes; and 

11 ‘‘(ii) communicates in writing the 

12 medical necessity to a certifying doctor of 

13 medicine or osteopathy for the individual 

14 to have therapeutic shoes along with find15 ings that the individual has peripheral neu16 ropathy with evidence of callus formation, 

17 a history of pre-ulcerative calluses, a his18 tory of previous ulceration, foot deformity, 

19 previous amputation, or poor circulation; 

20 and 

21 ‘‘(C) the therapeutic shoes are fitted and 

22 furnished by a podiatrist or other qualified sup23 plier individual (as established by the Sec24 retary), such as a pedorthist or orthotist, who 

25 is not the physician described in subparagraph 


jbell on DSK7SPTVN1PROD with BILLS
5 

•S 1318 IS

1 (A) (unless the Secretary finds that the physi2 cian is the only such qualified individual in the 

3 area);’’. 

4 (b) EFFECTIVE DATE.—The amendment made by 

5 subsection (a) shall apply with respect to items and serv6 ices furnished on or after January 1, 2014. 

7 SEC. 4. BUDGET SAVINGS: STRENGTHENING MEDICAID 

8 PROGRAM INTEGRITY THROUGH CONTIN9 UOUS LEVY ON PAYMENTS TO MEDICAID 

10 PROVIDERS AND SUPPLIERS. 

11 (a) IN GENERAL.—Section 6331(h)(2) of the Inter12 nal Revenue Code of 1986 (defining specified payment) 

13 is amended by striking ‘‘and’’ at the end of subparagraph 

14 (B), by striking the period at the end of subparagraph 

15 (C) and inserting ‘‘, and’’, and by adding at the end the 

16 following new subparagraph: 

17 ‘‘(D) any payment to any Medicaid pro18 vider or supplier under a State plan under title 

19 XIX of the Social Security Act.’’. 

20 (b) EFFECTIVE DATE.—The amendments made by 

21 this section shall apply to levies issued after the date of 

22 the enactment of this Act. 

Æ 


jbell on DSK7SPTVN1PROD with BILLS