I 
111TH CONGRESS 
1ST SESSION H. R. 2479 
To amend title XVIII of the Social Security Act to modify the designation 
of accreditation organizations for prosthetic devices and orthotics and 
prosthetics, to apply accreditation and licensure requirements to such 
devices and items for purposes of payment under the Medicare Program, 
and to modify the payment rules for such devices and items under 
such program to account for practitioner qualifications and complexity 
of care. 
IN THE HOUSE OF REPRESENTATIVES 
MAY 19, 2009 
Ms. BERKLEY introduced the following bill; which was referred to the Com-
mittee 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 XVIII of the Social Security Act to modify 
the designation of accreditation organizations for pros-
thetic devices and orthotics and prosthetics, to apply 
accreditation and licensure requirements to such devices 
and items for purposes of payment under the Medicare 
Program, and to modify the payment rules for such 
devices and items under such program to account for 
practitioner qualifications and complexity of care. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
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SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Medicare Orthotics and 
Prosthetics Improvement Act of 2009’’. 
SEC. 2. MODIFICATION OF REQUIREMENTS APPLICABLE 
UNDER MEDICARE TO DESIGNATION OF AC-
CREDITATION 
ORGANIZATIONS 
FOR 
SUP-
PLIERS 
OF 
PROSTHETIC 
DEVICES 
AND 
ORTHOTICS AND PROSTHETICS. 
(a) IN GENERAL.—Section 1834(a)(20)(B) of the So-
cial Security Act (42 U.S.C. 1395m(a)(20)(B)) is amend-
ed— 
(1) by striking ‘‘Not later than’’ and inserting 
‘‘(i) IN GENERAL.—Subject to clause (ii), not later 
than’’ with the same indentation as the clause added 
by paragraph (2); and 
(2) by adding at the end the following new 
clause: 
‘‘(ii) SPECIAL
REQUIREMENTS
FOR 
ACCREDITATION OF PROSTHETIC DEVICES 
AND ORTHOTICS AND PROSTHETICS.—For 
purposes of applying quality standards 
under subparagraph (A) for suppliers of 
items and services described in subpara-
graph (D)(ii), the Secretary shall designate 
and approve an independent accreditation 
organization under clause (i) only if such 
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organization is a Board or program de-
scribed in subsection (h)(1)(F)(iv). Not 
later than January 1, 2010, the Secretary 
shall ensure that at least one independent 
accreditation organization is designated 
and approved in accordance with this 
clause.’’. 
(b) EFFECTIVE DATE.—An organization must satisfy 
the requirement of section 1834(a)(20)(B)(ii), as added 
by subsection (a)(2), not later than January 1, 2010, re-
gardless of whether such organization is designated or ap-
proved as an independent accreditation organization be-
fore, on, or after the date of the enactment of this Act. 
SEC. 3. APPLICATION OF EXISTING ACCREDITATION AND 
LICENSURE REQUIREMENTS FOR CERTAIN 
PROSTHETICS 
AND 
CUSTOM-FABRICATED 
ORTHOTICS TO PROSTHETIC DEVICES AND 
ORTHOTICS AND PROSTHETICS. 
(a) IN GENERAL.—Section 1834(h)(1)(F) of the So-
cial Security Act (42 U.S.C. 1395m(h)(1)(F)) is amend-
ed— 
(1) in the heading, by striking ‘‘SPECIAL PAY-
MENT RULES FOR CERTAIN PROSTHETICS AND CUS-
TOM-FABRICATED ORTHOTICS’’ and inserting ‘‘PAY-
MENT RULES’’; 
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(2) in clause (i), by striking ‘‘an item of cus-
tom-fabricated orthotics described in clause (ii) or 
for an item of prosthetics unless such item is’’ and 
inserting ‘‘a prosthetic device or an item of orthotics 
or prosthetics, including an item of custom-fab-
ricated orthotics described in clause (ii), unless such 
device or item, respectively, is’’; 
(3) in clause (ii)(II), by striking ‘‘a list of items 
to which this subparagraph applies’’ and inserting 
‘‘a list of items for purposes of clause (i)’’; and 
(4) in clause (iii)(III), by striking ‘‘to provide 
or manage the provision of prosthetics and custom- 
designed or -fabricated orthotics’’ and inserting ‘‘to 
provide or manage the provision of prosthetics and 
orthotics 
(and 
custom-designed 
or 
-fabricated 
orthotics, in the case of an item described in clause 
(ii))’’. 
(b) EFFECTIVE DATE.—The amendments made by 
subsection (a) shall apply to devices and items furnished 
on or after January 1, 2010. 
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SEC. 4. MEDICARE PAYMENT RULES FOR PROSTHETIC DE-
VICES AND ORTHOTICS AND PROSTHETICS 
TO ACCOUNT FOR PRACTITIONER QUALI-
FICATIONS AND COMPLEXITY OF CARE. 
Section 1834(h) of the Social Security Act (42 U.S.C. 
1395m(h)) is amended— 
(1) in paragraph (1)(F)(iii), by striking ‘‘other 
individual who’’ and inserting ‘‘other individual who, 
with respect to a category of orthotics and pros-
thetics care described in clause (i), (ii), (iii), (iv), or 
(v) of paragraph (5)(C) furnished on or after Janu-
ary 1, 2010, satisfies all applicable criteria of the 
provider qualification designation for such category 
described in the respective clause, and who’’; 
(2) in paragraph (1)(F)(iv), by inserting before 
the period the following: ‘‘and, with respect to a cat-
egory of orthotics and prosthetics care described in 
clause (i), (ii), (iii), (iv), or (v) of paragraph (5)(C) 
and furnished on or after January 1, 2010, satisfies 
all applicable criteria of the provider qualification 
designation for such category described in the re-
spective clause’’; and 
(3) by adding at the end the following new 
paragraph: 
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