S3977-118

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 shall be made under this subsection for an item described in clause (ii) furnished to an individual via a drop shipment. This items described in this clause are the following: A prosthesis (as defined in paragraph (4)(C)), except that such term does not include supplies for such prosthesis. A custom-fabricated orthosis (as described in subparagraph (F)(ii)), or a custom-fitted orthosis, except that such term does not include supplies for such orthosis. Off-the-shelf orthotics (as defined in section 1847(a)(2)(C)) that are not otherwise subject to competitive bidding and are delivered by drop shipment. In this subparagraph, the term drop shipment means the direct shipment of a prosthesis or an orthosis to an individual that has not received training or education with respect to fitting and adjustment or training in the care and use of such prosthesis or orthosis from a qualified practitioner (as described in subparagraph (F)(iii)). The amendment made by paragraph (1) shall apply to items furnished on or after the first day of the first full calendar year following the date of enactment of this Act. 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 inserting , physical therapist, occupational therapist, orthotist, prosthetist after the physician’s in each place such term occurs. 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 orthotic devices, custom-fabricated orthotic devices, after Replacement of prosthetic devices; and in clause (i), by inserting , replacement of custom-fitted orthotic devices, replacement of custom-fabricated orthotic devices, after which are artificial limbs,. Section 1834(h)(4)(C) of the Social Security Act (42 U.S.C. 1395m(h)(4)(C)) is amended by striking the term orthotics and prosthetics has the meaning given such term, and inserting the terms orthotics and prosthetics and orthoses and prostheses have the meaning given such terms. 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 Act. (I)Prohibition on payment for certain items furnished using a drop shipment(i)In generalNo payment shall be made under this subsection for an item described in clause (ii) furnished to an individual via a drop shipment.(ii)Items describedThis items described in this clause are the following:(I)A prosthesis (as defined in paragraph (4)(C)), except that such term does not include supplies for such prosthesis.(II)A custom-fabricated orthosis (as described in subparagraph (F)(ii)), or a custom-fitted orthosis, except that such term does not include supplies for such orthosis.(III)Off-the-shelf orthotics (as defined in section 1847(a)(2)(C)) that are not otherwise subject to competitive bidding and are delivered by drop shipment.(iii)Drop shipment definedIn this subparagraph, the term drop shipment means the direct shipment of a prosthesis or an orthosis to an individual that has not received training or education with respect to fitting and adjustment or training in the care and use of such prosthesis or orthosis from a qualified practitioner (as described in subparagraph (F)(iii))..