I 
117TH CONGRESS 
1ST SESSION H. R. 1990 
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 pros-
thetics, and for other purposes. 
IN THE HOUSE OF REPRESENTATIVES 
MARCH 17, 2021 
Mr. THOMPSON of California (for himself, Mr. GUTHRIE, Mr. THOMPSON of 
Pennsylvania, and Mr. BUTTERFIELD) 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 subse-
quently 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 protect 
beneficiaries with limb loss and other orthopedic condi-
tions 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. 
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 Patient-Centered Care Act’’. 
SEC. 2. INCREASING PROTECTIONS FOR BENEFICIARIES 
RECEIVING 
ORTHOTIC 
AND 
PROSTHETIC 
CARE UNDER THE MEDICARE PROGRAM. 
(a) 
DISTINGUISHING
ORTHOTISTS
AND 
PROSTHETISTS FROM SUPPLIERS OF DURABLE MEDICAL 
EQUIPMENT AND SUPPLIES.—Section 1834 of the Social 
Security Act (42 U.S.C. 1395m) is amended— 
(1) in subsection (j)(5), by striking subpara-
graph (C) and redesignating the subsequent sub-
paragraphs accordingly; and 
(2) by adding at the end the following new sub-
section: 
‘‘(x) 
REQUIREMENTS
FOR
ORTHOTISTS
AND 
PROSTHETISTS.— 
‘‘(1) ISSUANCE
AND
RENEWAL
OF
SUPPLIER 
NUMBER.— 
‘‘(A) PAYMENT.— 
‘‘(i) IN GENERAL.—No payment may 
be made under this part to an orthotic or 
prosthetic supplier unless such orthotic or 
prosthetic supplier obtains (and renews at 
such intervals as the Secretary may re-
quire) a supplier number. 
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‘‘(ii) CLARIFICATION REGARDING PRO-
VIDERS
UNDER
PART
A.—Nothing in 
clause (i) shall prohibit a provider other-
wise permitted to receive payment for 
orthotics and prosthetics under part A 
from continuing to receive payment under 
such part without interruption. 
‘‘(B) STANDARDS FOR POSSESSING A SUP-
PLIER NUMBER.—An orthotic or prosthetic sup-
plier may only obtain a supplier number if the 
supplier meets standards prescribed by the Sec-
retary that include requirements that the 
orthotic or prosthetic supplier (and, where ap-
plicable, the orthotist or prosthetist)— 
‘‘(i) licensure and accreditation— 
‘‘(I) complies with all applicable 
State and Federal licensure and regu-
latory requirements; and 
‘‘(II) acquires accreditation from 
the American Board for Certification 
in Orthotics, Prosthetics and Pedorth-
ics, Inc. or the Board of Certification/ 
Accreditation, International, or other 
accreditation entity that the Secretary 
determines has standards that are 
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equivalent to the standards of such 
Boards; 
‘‘(ii) maintains a physical facility on 
an appropriate site; 
‘‘(iii) has proof of appropriate liability 
insurance; and 
‘‘(iv) meets such other requirements 
as the Secretary shall specify. 
‘‘(C) PROHIBITION
AGAINST
MULTIPLE 
SUPPLIER NUMBERS.—The Secretary may not 
issue more than one supplier number to any 
orthotic or prosthetic supplier unless the Sec-
retary finds that the issuance of more than one 
number is appropriate to identify other entities 
under the ownership or control of the orthotic 
or prosthetic supplier. 
‘‘(2) 
ORDER
FOR
ORTHOTICS
OR
PROS-
THETICS.— 
‘‘(A) 
INFORMATION
PROVIDED
BY 
ORTHOTISTS AND PROSTHETISTS ON DETAILED 
WRITTEN ORDERS FOR ORTHOTICS AND PROS-
THETICS.—An orthotist or prosthetist may dis-
tribute to physicians, physician assistants, 
nurse practitioners, clinical nurse specialists, or 
individuals entitled to benefits under this part, 
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a detailed written order for orthotics or pros-
thetics (as defined in paragraph (5)) for com-
mercial purposes that contains the following in-
formation: 
‘‘(i) The identification of— 
‘‘(I) the orthotic or prosthetic 
supplier; and 
‘‘(II) the individual to whom the 
orthotics or prosthetics are furnished. 
‘‘(ii) The identification of the treating 
physician, physician assistant, nurse prac-
titioner, or clinical nurse specialist. 
‘‘(iii) A description of the orthotics or 
prosthetics ordered. 
‘‘(iv) The date of the order described 
in this subparagraph. 
‘‘(B) 
INFORMATION
ON
CODING
AND 
DESCRIPTORS OF COMPONENTS PROVIDED.—If 
an orthotist or prosthetist distributes a detailed 
written order for orthotics or prosthetics de-
scribed in subparagraph (A), the orthotist or 
prosthetist shall also list on the order the sum-
mary descriptors of the items and services being 
recommended prior to submission of the order 
to the treating physician for approval. 
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‘‘(C) SIGNATURE
BY
TREATING
PHYSI-
CIAN.—A detailed written order for orthotics or 
prosthetics described in subparagraph (A) shall 
be signed by the treating physician. 
‘‘(3) LIMITATION ON PATIENT LIABILITY.—Ex-
cept as provided in paragraph (4), if an orthotist or 
prosthetist— 
‘‘(A) furnishes an orthosis or prosthesis to 
a beneficiary for which no payment may be 
made under this part; or 
‘‘(B) subject to section 1879, furnishes an 
orthosis or prosthesis to a beneficiary for which 
payment is denied under section 1862(a)(1), 
any expenses incurred for the orthosis or prosthesis 
furnished to an individual by the orthotist or pros-
thetist not on an assigned basis shall be the respon-
sibility of such orthotist or prosthetist. The indi-
vidual shall have no financial responsibility for such 
expenses and the orthotist or prosthetist shall refund 
on a timely basis to the individual (and shall be lia-
ble to the individual for) any amounts collected from 
the individual for such items and services. The pro-
visions of subsection (a)(18) shall apply to refunds 
required under the previous sentence in the same 
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manner as such provisions apply to refunds under 
such subsection. 
‘‘(4) PATIENT
LIABILITY.—If an orthotist or 
prosthetist furnishes an orthosis or prosthesis to a 
patient for which payment is denied in advance 
under subsection (a)(15), expenses incurred for such 
orthosis or prosthesis furnished to the individual by 
the orthotist or prosthetist shall be the responsibility 
of the individual. 
‘‘(5) DEFINITIONS.—In this subsection: 
‘‘(A) DETAILED
WRITTEN
ORDER
FOR 
ORTHOTICS OR PROSTHETICS.— 
‘‘(i) IN GENERAL.—The term ‘detailed 
written order for orthotics or prosthetics’ 
means a form or other document prepared 
by an orthotist or prosthetist and signed 
by the physician (as defined by section 
1861(r)) that contains information re-
quired by the Secretary to show that an 
orthosis or prosthesis is reasonable and 
necessary for the treatment of an illness or 
injury or to improve the functioning of a 
malformed body member. 
‘‘(ii) CLARIFICATION.—The detailed 
written order for orthotics or prosthetics 
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shall not be considered alone for purposes 
of determining the reasonableness, medical 
necessity, and functional level (applicable 
to prosthetics) of orthotics and prosthetics. 
‘‘(B) ORTHOTICS AND PROSTHETICS.—The 
term ‘orthotics and prosthetics’ has the mean-
ing given that term in section 1834(h)(4)(C). 
‘‘(C) ORTHOTIST OR PROSTHETIST.—The 
term ‘orthotist or prosthetist’ means an indi-
vidual who is specifically trained and educated 
in the provision of, and patient care manage-
ment related to, prosthetics and custom-fab-
ricated or custom-fit orthotics, and— 
‘‘(i) in the case of a State that pro-
vides for the licensing of orthotists and 
prosthetists, is licensed by the State in 
which the orthotics or prosthetics were 
supplied; or 
‘‘(ii) in the case of a State that does 
not provide for the licensing of orthotists 
and prosthetists, is certified by the Amer-
ican Board for Certification in Orthotics, 
Prosthetics and Pedorthics, Inc. or by the 
Board of Certification/Accreditation, Inter-
national, or is certified and approved by an 
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entity that the Secretary determines has 
certification and approval standards that 
are essentially equivalent to the certifi-
cation and approval standards of such 
Boards.’’. 
(b) 
PROHIBITING
PAYMENT
FOR
CERTAIN 
ORTHOTICS AND PROSTHETICS.—Section 1834(h)(1) of 
the Social Security Act (42 U.S.C. 1395m(h)(1)) is 
amended by adding at the end the following new subpara-
graph: 
‘‘(I) 
SPECIAL
PAYMENT
RULES
FOR 
ORTHOTICS OR PROSTHETICS.— 
‘‘(i) IN GENERAL.—No payment shall 
be made under this subsection for— 
‘‘(I) a prosthesis (excluding pros-
thetic supplies) that is delivered by 
drop shipment; 
‘‘(II) a custom-fabricated or cus-
tom-fitted orthosis (excluding orthotic 
supplies) described in subparagraph 
(F)(ii) that is delivered by drop ship-
ment; and 
‘‘(III) an orthotic item that is 
not otherwise competitively bid that is 
delivered by drop shipment. 
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‘‘(ii) DROP SHIPMENT DEFINED.—In 
this subparagraph, the term ‘drop ship-
ment’ means the shipping of an orthosis or 
prosthesis to a beneficiary without receiv-
ing from a trained, educated, and certified 
or 
licensed 
health 
care 
practitioner, 
orthotist, or prosthetist direct patient care 
with respect to assessing, adjusting, and 
training in the care and use of the orthosis 
or prosthesis.’’. 
(c) 
STANDARDIZING
THE
DEFINITIONS
OF 
ORTHOTICS AND PROSTHETICS.—Section 1834(h)(4) of 
the Social Security Act (42 U.S.C. 1395m(h)(4)) is 
amended— 
(1) in subparagraph (B), by striking at the end 
‘‘and’’; 
(2) in subparagraph (C)— 
(A) by striking ‘‘the term ‘orthotics and 
prosthetics’ has the meaning given such term’’ 
and inserting ‘‘the terms ‘orthotics and pros-
thetics’ and ‘orthoses and prostheses’ have the 
meaning given such terms’’; and 
(B) by striking the period at the end and 
inserting ‘‘; and’’; and 
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(3) by inserting after subparagraph (C), as 
amended by paragraph (2), the following new sub-
paragraph: 
‘‘(D) the terms ‘prosthetics’ and ‘pros-
theses’ refer to a device (including the clinical 
services associated with such device) that re-
places all or part of a limb.’’. 
(d) LIMITATION OF COMPETITIVE ACQUISITION FOR 
OFF-THE-SHELF ORTHOTICS.—Section 1847(a) of the 
Social Security Act (42 U.S.C. 1395w–3(a)) is amended— 
(1) in paragraph (2)(C), by inserting ‘‘by the 
patient (and not by another person)’’ after ‘‘minimal 
self-adjustment’’; and 
(2) in paragraph (7)(A)(i)— 
(A) by inserting ‘‘, orthotist or prosthetist 
(as defined in section 1834(x)(5)(C)),’’ after 
‘‘by a physician’’; 
(B) by inserting ‘‘, orthotist’s or prosthet-
ist’s,’’ after ‘‘to the physician’s’’; and 
(C) by inserting ‘‘, orthotist’s or prosthet-
ist’s,’’ after ‘‘of the physician’s’’. 
(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 
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implement the provisions of, and amendments made by, 
this Act. 
Æ 
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