(5) by adding at the end the following new 
clause: 
‘‘(v) EXEMPTION OF OFF-THE-SHELF 
ORTHOTICS INCLUDED IN A COMPETITIVE 
ACQUISITION
PROGRAM.—This 
subpara-
graph shall not apply to an item of 
orthotics described in paragraph (2)(C) of 
section 1847(a) furnished on or after Jan-
uary 1, 2014, that is included in a com-
petitive acquisition program in a competi-
tive acquisition area under such section.’’. 
(b) EFFECTIVE DATE.—The amendments made by 
subsection (a) shall apply to orthotics and prosthetics fur-
nished on or after January 1, 2014. 
SEC. 
4. 
ELIGIBILITY 
FOR 
MEDICARE 
PAYMENT 
FOR 
ORTHOTICS AND PROSTHETICS BASED ON 
SUPPLIER 
QUALIFICATIONS 
AND 
COM-
PLEXITY OF CARE. 
Section 1834(h) of the Social Security Act (42 U.S.C. 
1395m(h)) is amended— 
(1) in paragraph (1)(F)(iii), in the matter pre-
ceding subclause (I), by striking ‘‘other individual 
who’’ and inserting ‘‘other individual who, with re-
spect to a category of orthotics and prosthetics care 
described in clause (i), (ii), (iii), (iv), or (v) of para-
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graph (5)(C) furnished on or after January 1, 2014, 
and subject to paragraph (5)(A), satisfies all appli-
cable criteria of the supplier qualification designa-
tion 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) 
furnished on or after January 1, 2014, and subject 
to paragraph (5)(A), satisfies all applicable criteria 
of the provider qualification designation for such 
category described in the respective clause’’; and 
(3) by adding at the end the following new 
paragraph: 
‘‘(5) ELIGIBILITY
FOR
PAYMENT
BASED
ON 
SUPPLIER
QUALIFICATIONS
AND
COMPLEXITY
OF 
CARE.— 
‘‘(A) CONSIDERATIONS
FOR
ELIGIBILITY 
FOR PAYMENTS.— 
‘‘(i) 
IN
GENERAL.—In 
applying 
clauses (iii) and (iv) of paragraph (1)(F) 
for purposes of determining whether pay-
ment may be made under this subsection 
for orthotics and prosthetics furnished on 
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or after January 1, 2014, the Secretary 
shall take into account the complexity of 
the respective item and, subject to clauses 
(ii), (iii), and (iv), the qualifications of the 
individual or entity furnishing and fabri-
cating such respective item in accordance 
with this paragraph. 
‘‘(ii) INDIVIDUAL AND ENTITIES EX-
EMPTED FROM SUPPLIER QUALIFICATION 
DESIGNATION CRITERIA.—With respect to 
an item of orthotics or prosthetics de-
scribed in clause (ii), (iii), (iv) or (v) of 
subparagraph (C), any criteria for the sup-
plier qualification designations under such 
respective clause, including application of 
subparagraph (D), shall not apply to phy-
sicians, occupational therapists, or physical 
therapists who are licensed or otherwise 
regulated by the State in which they are 
practicing and who receive payment under 
this title, including regulations promul-
gated pursuant to this subsection, for the 
provision of orthotics and prosthetics. 
‘‘(iii) SUPPLIERS MEDICARE-ELIGIBLE 
PRIOR TO JANUARY 1, 2014, EXEMPTED.— 
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In the case of a qualified supplier who is 
eligible to receive payment under this title 
before January 1, 2014— 
‘‘(I) with respect to an item of 
orthotics or prosthetics described in 
clause (i) of subparagraph (C), any 
criteria for the provider qualification 
designations under such clause, in-
cluding application of subparagraph 
(D), shall not apply to such supplier, 
respectively, for the furnishing or fab-
rication of such an item so described; 
and 
‘‘(II) with respect to an item of 
orthotics or prosthetics described in 
clause (ii), (iii), or (iv) of subpara-
graph (C), any criteria for the sup-
plier qualification designations under 
the respective clause (or a subsequent 
clause of such subparagraph), includ-
ing application of subparagraph (D), 
shall not apply to such supplier, re-
spectively, for the furnishing or fab-
rication of such an item described in 
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such respective (or such subsequent) 
clause. 
‘‘(iv) DELAYED APPLICATION OF CER-
TAIN SUPPLIER QUALIFICATION DESIGNA-
TION
CRITERIA.—The supplier qualifica-
tion designations under clauses (i), (ii), 
and (iii) of subparagraph (C), including 
the application of subparagraph (D) to 
such clauses, shall not be taken into ac-
count with respect to payment made under 
this subsection for orthotics and pros-
thetics furnished before January 1, 2015. 
‘‘(v) MODIFICATIONS.—The Secretary 
shall, in consultation with the Boards and 
programs 
described 
in 
paragraph 
(1)(F)(iv), periodically review the criteria 
for the supplier qualification designation 
under subparagraph (C)(i)(III) and may 
implement by regulation any modifications 
to such criteria, as determined appropriate 
in accordance with such consultation. Any 
such modification shall take effect no ear-
lier than January 1, 2016. 
‘‘(B) ASSIGNMENT OF BILLING CODES.— 
For purposes of subparagraph (A), the Sec-
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