S2329-119

1. Short title This Act may be cited as the Medicare Orthotics and Prosthetics Patient-Centered Care Act.

2. Increasing protections for Medicare beneficiaries receiving orthotic and prosthetic care 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 subparagraph: No payment may be made under this subsection for an item described in clause (ii) furnished to an individual via a drop shipment on or after the first day of the first year beginning after the date of the enactment of this subparagraph. The items described in this clause are orthotics and prosthetics, not including supplies for such orthotics and prosthetics, that are identified by HCPCS codes for which payment is not made under section 1847. In this subparagraph, the term drop shipment means, with respect to an item described in clause (ii), the direct shipment of such item to an individual who has not received training or education from a qualified practitioner (as defined in subparagraph (F)(iii)) on the fitting and adjustment, care, and use of such item. Section 1847(a)(7)(A)(i) of the Social Security Act (42 U.S.C. 1395w–3(a)(7)(A)(i)) is amended— by inserting , physical therapist, occupational therapist, orthotist, prosthetist, after by a physician; and by striking the physician’s each place it appears and inserting such physician’s in each such place. Section 1834(h)(1)(G) of the Social Security Act (42 U.S.C. 1395m(h)(1)(G)) is amended— in the heading, by inserting , custom-fitted orthotics, custom-fabricated orthotics, after Replacement of prosthetic devices; and in clause (i), by inserting replacement of custom-fitted orthotics, replacement of items of custom-fabricated orthotics described in subparagraph (F)(ii), after which are artificial limbs,. 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 implement the amendments made by this section. (I)Prohibition on payment for certain items furnished using a drop shipment(i)In generalNo payment may be made under this subsection for an item described in clause (ii) furnished to an individual via a drop shipment on or after the first day of the first year beginning after the date of the enactment of this subparagraph.(ii)Items describedThe items described in this clause are orthotics and prosthetics, not including supplies for such orthotics and prosthetics, that are identified by HCPCS codes for which payment is not made under section 1847.(iii)Drop shipment definedIn this subparagraph, the term drop shipment means, with respect to an item described in clause (ii), the direct shipment of such item to an individual who has not received training or education from a qualified practitioner (as defined in subparagraph (F)(iii)) on the fitting and adjustment, care, and use of such item..