Medicare Orthotics and Prosthetics Patient-Centered Care Act

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. 1. Short title This Act may be cited as the Medicare Orthotics and Prosthetics Patient-Centered Care Act 2. Increasing protections for Medicare beneficiaries receiving orthotic and prosthetic care (a) Prohibition on payment for items delivered by drop shipment (1) In general Section 1834(h)(1) of the Social Security Act ( 42 U.S.C. 1395m(h)(1) (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 subparagraph (H)(4)(B)), 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 delivered by drop shipment. (iii) Drop shipment defined In this subparagraph, the term drop shipment . (2) 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. (b) 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) (1) by inserting , physical therapist, occupational therapist, orthotist, prosthetist by a physician (2) by inserting , physical therapist, occupational therapist, orthotist, prosthetist the physician’s (c) 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) (1) in the heading, by inserting , custom-fitted orthotic devices, custom-fabricated orthotic devices Replacement of prosthetic devices (2) in clause (i), by inserting , replacement of custom-fitted orthotic devices, replacement of custom-fabricated orthotic devices, which are artificial limbs, (d) Updating definitions of orthotics and prosthetics Section 1834(h)(4)(C) of the Social Security Act ( 42 U.S.C. 1395m(h)(4)(C) the term orthotics and prosthetics the terms orthotics and prosthetics orthoses and prostheses (e) 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.

Summary: Medicare Orthotics and Prosthetics Patient-Centered Care ActThis bill prohibits payment under Medicare for a prosthesis, custom-fabricated orthosis, or off-the-shelf orthotics that is delivered via a drop shipment (i.e., shipped to an individual who does not have training in how to properly fit or care for the device). It also specifically allows for payment of replacements of custom-fitted devices.