I 

116TH CONGRESS 

1ST SESSION H. R. 2235 

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 HOUSE OF REPRESENTATIVES 

APRIL 10, 2019 

Ms. DEGETTE (for herself, Mr. JOHNSON of Ohio, Mr. FLEISCHMANN, Mr. 

LUJA ́N, Ms. MATSUI, Mrs. WALORSKI, Mr. WENSTRUP, Mr. YARMUTH, 

Mr. RODNEY DAVIS of Illinois, Mr. SMITH of New Jersey, Mrs. DINGELL, 

and Mr. DESJARLAIS) introduced the following bill; which was referred 

to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined 

by the Speaker, in each case for consideration of such provisions as fall 

within the jurisdiction of the committee concerned 

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, 


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1 SECTION 1. SHORT TITLE. 

2 This Act may be cited as the ‘‘Helping Ensure Life3 and Limb-Saving Access to Podiatric Physicians Act’’ or 

4 the ‘‘HELLPP Act’’. 

5 SEC. 2. RECOGNIZING DOCTORS OF PODIATRIC MEDICINE 

6 AS PHYSICIANS UNDER THE MEDICAID PRO7 GRAM. 

8 (a) IN GENERAL.—Section 1905(a)(5)(A) of the So9 cial Security Act (42 U.S.C. 1396d(a)(5)(A)) is amended 

10 by striking ‘‘section 1861(r)(1)’’ and inserting ‘‘para11 graphs (1) and (3) of section 1861(r)’’. 

12 (b) EFFECTIVE DATE.— 

13 (1) IN GENERAL.—Except as provided in para14 graph (2), the amendment made by subsection (a) 

15 shall apply to services furnished on or after January 

16 1, 2020. 

17 (2) EXTENSION OF EFFECTIVE DATE FOR

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

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

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

21 and Human Services determines requires State legis22 lation in order for the plan to meet the additional 

23 requirement imposed by the amendment made by 

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

25 as failing to comply with the requirements of such 

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


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1 additional requirements before the first day of the 

2 first calendar quarter beginning after the close of 

3 the first regular session of the State legislature that 

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

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

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

7 of the session is considered to be a separate regular 

8 session of the State legislature. 

9 SEC. 3. CLARIFYING MEDICARE DOCUMENTATION RE10 QUIREMENTS FOR THERAPEUTIC SHOES FOR 

11 PERSONS WITH DIABETES. 

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

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

14 as follows: 

15 ‘‘(12) subject to section 4072(e) of the Omni16 bus Budget Reconciliation Act of 1987, extra-depth 

17 shoes with inserts or custom molded shoes with in18 serts (in this paragraph referred to as ‘therapeutic 

19 shoes’) for an individual with diabetes, if— 

20 ‘‘(A) the physician who is managing the in21 dividual’s diabetic condition— 

22 ‘‘(i) documents that the individual has 

23 diabetes; 


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1 ‘‘(ii) certifies that the individual is 

2 under a comprehensive plan of care related 

3 to the individual’s diabetic condition; and 

4 ‘‘(iii) documents agreement with the 

5 prescribing podiatrist or other qualified 

6 physician (as established by the Secretary) 

7 that it is medically necessary for the indi8 vidual to have therapeutic shoes; 

9 ‘‘(B) the therapeutic shoes are prescribed 

10 by a podiatrist or other qualified physician (as 

11 established by the Secretary) who— 

12 ‘‘(i) examines the individual and de13 termines the medical necessity for the indi14 vidual to receive the therapeutic shoes; and 

15 ‘‘(ii) communicates in writing the 

16 medical necessity to a certifying doctor of 

17 medicine or osteopathy for the individual 

18 to have therapeutic shoes along with find19 ings that the individual has peripheral neu20 ropathy with evidence of callus formation, 

21 a history of pre-ulcerative calluses, a his22 tory of previous ulceration, foot deformity, 

23 previous amputation, or poor circulation; 

24 and 


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

2 furnished by a podiatrist or other qualified sup3 plier individual (as established by the Sec4 retary), such as a pedorthist or orthotist, who 

5 is not the physician described in subparagraph 

6 (A) (unless the Secretary finds that the physi7 cian is the only such qualified individual in the 

8 area);’’. 

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

10 subsection (a) shall apply with respect to items and serv11 ices furnished on or after January 1, 2020. 

12 (c) RULE OF CONSTRUCTION.—Nothing in this sec13 tion shall be construed as expanding Medicare coverage 

14 for therapeutic shoes for individuals with diabetes. 

15 SEC. 4. BUDGET SAVINGS: STRENGTHENING MEDICAID 

16 PROGRAM INTEGRITY THROUGH CONTIN17 UOUS LEVY ON PAYMENTS TO MEDICAID 

18 PROVIDERS AND SUPPLIERS. 

19 (a) IN GENERAL.—Section 6331(h)(2) of the Inter20 nal Revenue Code of 1986 (defining specified payment) 

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

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

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

24 following new subparagraph: 


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1 ‘‘(D) any payment to any Medicaid pro2 vider or supplier under a State plan under title 

3 XIX of the Social Security Act.’’. 

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

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

6 the enactment of this Act. 

Æ 


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