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.
Sponsors
Legislative Progress
IntroducedMr. Thompson of Pennsylvania (for himself, Mr. Thompson of California, …
Summary
What This Bill Does
This bill amends Medicare payment rules (Title XVIII of the Social Security Act) to regulate how orthotics and prosthetics are delivered to beneficiaries. Key provisions:
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Prohibits Drop Shipments: Bans Medicare payment for orthotics/prosthetics that are directly shipped to patients without the patient first receiving training from a qualified practitioner on fitting, adjustment, care, and use of the device.
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Expands Qualified Practitioners: Adds physical therapists, occupational therapists, orthotists, and prosthetists to the list of practitioners who can provide required certification for durable medical equipment.
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Enhances Replacement Coverage: Extends replacement coverage rules (previously just for prosthetic devices) to include custom-fitted and custom-fabricated orthotics.
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Regulatory Mandate: Requires the Secretary of HHS to issue final regulations within 1 year of enactment.
Who Benefits and How
- Medicare beneficiaries with limb loss/orthopedic conditions: Improved quality of care through mandatory in-person fitting and training; safer device use through proper education
- Orthotists and Prosthetists: Practice protection through recognition as qualified practitioners; increased patient volume as drop-ship model is banned
- Physical Therapists and Occupational Therapists: Expanded scope as authorized practitioners for O&P certification
- Quality O&P Providers: Competitive advantage as drop-ship competitors are eliminated from Medicare reimbursement
Who Bears the Burden and How
- Drop-ship O&P Suppliers: Loss of Medicare reimbursement for their business model; must shift to practitioner-based service delivery
- CMS/HHS: Administrative burden to create new regulations and enforce drop shipment prohibition
- Some Medicare beneficiaries: May face reduced convenience or longer wait times if they previously used drop-ship services
Key Provisions
- Section 2(a): Prohibits Medicare payment for orthotics/prosthetics delivered via drop shipment
- Section 2(b): Expands definition of qualified practitioners to include PTs, OTs, orthotists, prosthetists
- Section 2(c): Extends replacement coverage to custom-fitted and custom-fabricated orthotics
- Section 2(d): Mandates HHS regulatory implementation within 1 year
Evidence Chain:
This summary is derived from the structured analysis below. See "Detailed Analysis" for per-title beneficiaries/burden bearers with clause-level evidence links.
Primary Purpose
Reforms Medicare coverage of orthotics and prosthetics (O&P) to ensure beneficiaries with limb loss receive quality patient-centered care through qualified practitioners, while reducing fraud by prohibiting drop shipments and requiring proper fitting education.
Policy Domains
Medicare Orthotics and Prosthetics Patient-Centered Care Act
Likely Beneficiaries
- Medicare beneficiaries with limb loss
- Orthotists and Prosthetists
- Physical Therapists
- Occupational Therapists
- Quality O&P providers
Likely Burden Bearers
- Drop-ship O&P suppliers
- CMS/HHS
Bill Structure & Actor Mappings
Who is "The Secretary" in each section?
- "cms"
- → Centers for Medicare & Medicaid Services
- "the_secretary"
- → Secretary of Health and Human Services
Key Definitions
Terms defined in this bill
The direct shipment of orthotics or prosthetics to an individual who has not received training or education from a qualified practitioner on the fitting and adjustment, care, and use of such item
Expanded to include physician, physical therapist, occupational therapist, orthotist, or prosthetist who can certify the need for durable medical equipment
We use a combination of our own taxonomy and classification in addition to large language models to assess meaning and potential beneficiaries. High confidence means strong textual evidence. Always verify with the original bill text.
Learn more about our methodology