I
106TH CONGRESS
2D SESSION
H. R. 5156
To amend title XVIII of the Social Security Act to establish standards
for payment under the Medicare Program for certain orthotic, prosthetic,
and pedorthic devices.
IN THE HOUSE OF REPRESENTATIVES
SEPTEMBER 12, 2000
Mrs. MCCARTHY of New York introduced the following bill; which was re-
ferred to the Committee on 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 establish
standards for payment under the Medicare Program for
certain orthotic, prosthetic, and pedorthic devices.
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled,
SECTION 1. STANDARDS REGARDING PAYMENT FOR CER-
TAIN 
ORTHOTICS, 
PROSTHETICS, 
AND
PEDORTHICS.
(a) STANDARDS.—Section 1834(h)(1) of the Social
Security Act (42 U.S.C. 1395m(h)(1)) is amended by add-
ing at the end the following new subparagraph
‘‘(F) ESTABLISHMENT OF STANDARDS FOR
CERTAIN ITEMS.—
‘‘(i) IN GENERAL.—No payment shall
be made for an applicable item unless the
item is provided by a qualified practitioner
or a qualified supplier under the system es-
tablished by the Secretary under clause
(iii). For purposes of the preceding sen-
tence, if a qualified practitioner or a quali-
fied supplier contracts with an entity to
provide an applicable item, then no pay-
ment shall be made for such item unless
the entity is also a qualified supplier.
‘‘(ii) DEFINITIONS.—In this subpara-
graph:
‘‘(I) 
APPLICABLE
ITEM.—The
term 
‘applicable 
item’ 
means
orthotics, prosthetics, and pedorthics
that require education, training, and
experience to dispense such item as a
part of a treatment plan.
‘‘(II) 
QUALIFIED
PRACTI-
TIONER.—The term ‘qualified practi-
tioner’ means a physician or health
care professional who—
‘‘(aa) is specifically trained
and educated to provide or man-
age the provision of custom-de-
signed, fabricated, modified, and
fitted orthotics, prosthetics, and
pedorthics, and is certified by the
American Board for Certification
in Orthotics and Prosthetics,
Inc., to dispense orthotics, pros-
thetics, or pedorthic devices, is
specifically trained and educated
to provide or manage the provi-
sion of custom-designed, fab-
ricated, 
modified, 
and 
fitted
pedorthics and is certified by the
Board 
for 
Certification 
in
Pedorthics to dispense pedorthic
devices, or is credentialed and
approved by a program that the
Secretary determines, in con-
sultation with appropriate ex-
perts in orthotics, prosthetics,
and pedorthics, has training and
education standards that are nec-
essary 
to 
provide 
applicable
items;
‘‘(bb) 
is 
licensed 
in
orthotics, 
prosthetics, 
or
pedorthics by the State in which
the applicable item is supplied; or
‘‘(cc) has completed at least
10 years of practice in the provi-
sion of applicable items.
‘‘(III) QUALIFIED
SUPPLIER.—
The term ‘qualified supplier’ means
any entity that is—
‘‘(aa) 
accredited 
by 
the
American Board for Certification
in Orthotics and Prosthetics,
Inc.;
‘‘(bb) 
accredited 
by 
the
Board 
for 
Certification 
in
Pedorthics, 
Inc., 
to 
dispense
pedorthic devices; or
‘‘(cc) accredited and ap-
proved by a program that the
Secretary determines has accredi-
tation and approval standards
that are essentially equivalent to
those of such Boards.
‘‘(iii) SYSTEM.—The Secretary, in
consultation with appropriate experts in
orthotics, prosthetics, and pedorthics, shall
establish a system under which the Sec-
retary shall—
‘‘(I) determine which items are
applicable items and formulate a list
of such items;
‘‘(II) review the applicable items
billed under the coding system estab-
lished under this title; and
‘‘(III) limit payment for applica-
ble items pursuant to clause (i).’’.
(b) REVISION OF DEFINITION OF ORTHOTICS.—Sec-
tion 1861(s)(9) of the Social Security Act (42 U.S.C.
1395x(s)(9)) is amended by inserting ‘‘(including such
braces that are used in conjunction with, or as components
of, other medical or nonmedical equipment when provided
by a qualified practitioner (as defined in subclause (II)
of section 1834(h)(1)(F)(ii)) or a qualified supplier (as de-
fined in subclause (III) of such section)’’ after ‘‘braces’’.
(c) DEFINITION OF PEDORTHIC DEVICES.—
(1) IN GENERAL.—Section 1861(s) of the So-
cial Security Act (42 U.S.C. 1395x(s)) is amended—
(A) by redesignating paragraphs (16) and
(17) as paragraphs (17) and (18), respectively;
(B) by striking ‘‘and’’ at the end of para-
graph (14);
(C) by striking the period at the end of
paragraph (15) and inserting ‘‘; and’’; and
(D) by inserting after paragraph (15) the
following new paragraph:
‘‘(16)(A) pedorthic devices consisting of thera-
peutic shoes, shoe modifications made for thera-
peutic purposes, partial foot prostheses, and foot
orthoses for use from the ankle and below, but not
including non-therapeutic, accommodative inlays and
non-therapeutic accommodative footwear (regardless
of method of manufacture) or prefabricated foot care
products; and
‘‘(B) in subparagraph (A)—
‘‘(i) a pedorthic device is therapeutic if the
device addresses a medical condition and is pre-
scribed by a physician or practitioner; and
‘‘(ii) an inlay or footwear is accommodative
is an inlay or footwear that is designed with a