Medicare Orthotics and Prosthetics Patient-Centered Care Act
The Medicare Orthotics and Prosthetics Patient-Centered Care Act would strengthen protections for Medicare beneficiaries receiving orthotics and prosthetics (O&P) and aim to improve access to properly fitted, safe, and effective devices. Key changes include prohibiting payment for certain O&P items that are drop-shipped directly to patients without prior training from a qualified practitioner, expanding the list of practitioners exempt from competitive bidding rules (to include physical therapists, occupational therapists, orthotists, and prosthetists), and ensuring coverage for replacement of custom-fitted or custom-fabricated orthotics. The bill also requires the Secretary of Health and Human Services to issue final regulations within one year to implement these amendments. Overall, the bill targets fraud and waste while promoting patient-centered O&P care and beneficiary access to appropriate devices.
Key Points
- 1Prohibition on payment for drop-shipped O&P items: Payment cannot be made for orthotics and prosthetics that are shipped directly to a patient who has not received training from a qualified practitioner on fitting, use, and care, effective after enactment.
- 2Expanded exempt professionals from competitive bidding: Physical therapists, occupational therapists, orthotists, and prosthetists would be added to the list of practitioners exempt from certain competitive acquisition requirements for O&P/DME, beyond physicians.
- 3Protection and expansion of replacement coverage for custom O&P: The law would explicitly cover replacement of custom-fitted orthotics and custom-fabricated orthotic devices, with terminology updated to reflect these categories.
- 4Regulatory timeline: The Secretary of Health and Human Services must issue final regulations to implement these changes within one year of enactment.
- 5Overall goal: Reduce fraud, waste, and abuse in orthotics and prosthetics while improving access to appropriate, patient-centered care for beneficiaries with limb loss and other orthopedic conditions.