Medicare Orthotics and Prosthetics Patient-Centered Care Act
The Medicare Orthotics and Prosthetics Patient-Centered Care Act would amend the Medicare statute (Title XVIII of the Social Security Act) to strengthen safeguards around orthotics and prosthetics (O&P) services and products. Key changes include prohibiting Medicare payment for O&P items that are drop-shipped directly to patients who have not received training from a qualified practitioner, broadening the group of providers exempt from certain competitive bidding rules to include physical therapists, occupational therapists, orthotists, and prosthetists, and ensuring that beneficiaries have access to replacement custom-fitted and custom-fabricated orthotics. The bill also requires the Secretary of Health and Human Services to issue final regulations within one year to implement these changes. Overall, the bill aims to improve patient safety, reduce fraud or abuse related to O&P, and improve patient-centered access to appropriate devices.
Key Points
- 1Prohibition on payment for drop-shipped items: Medicare cannot pay for orthotics or prosthetics that are drop-shipped to a patient unless the patient has received fitting, adjustment, care, and use training from a qualified practitioner. Drop shipment is defined as shipping directly to a patient who has not received such training.
- 2Expanded exemptions from competitive acquisition: The bill adds physical therapists, occupational therapists, orthotists, and prosthetists to the list of practitioners eligible for exemptions from the competitive bidding requirements in Medicare Part B for certain O&P items.
- 3Access to replacement custom devices: The law would explicitly protect beneficiary access to replacement of custom-fitted orthotics and custom-fabricated orthotic devices, expanding or clarifying coverage for these high-tailored items.
- 4Regulatory timeline: The Secretary of Health and Human Services must issue final regulations within one year of enactment to implement these amendments.
- 5Overall objective: To protect beneficiaries with limb loss or orthopedic conditions, improve safety and effectiveness of O&P care, and reduce fraud, waste, and abuse related to orthotics and prosthetics.