Medicare Orthotics and Prosthetics Patient-Centered Care Act

[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[H.R. 4475 Introduced in House (IH)]

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119th CONGRESS
  1st Session
                                H. R. 4475

      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.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                             July 17, 2025

Mr. Thompson of Pennsylvania (for himself, Mr. Thompson of California, 
 Mr. Bilirakis, and Mrs. Dingell) introduced the following bill; which 
 was referred to the Committee on Energy and Commerce, and in addition 
  to the Committee on Ways and Means, for a period to be subsequently 
   determined by the Speaker, in each case for consideration of such 
 provisions as fall within the jurisdiction of the committee concerned

_______________________________________________________________________

                                 A BILL


 
      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.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Medicare Orthotics and Prosthetics 
Patient-Centered Care Act''.

SEC. 2. INCREASING PROTECTIONS FOR MEDICARE BENEFICIARIES RECEIVING 
              ORTHOTIC AND PROSTHETIC CARE.

    (a) Prohibition on Payment for Items Delivered by Drop Shipment.--
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:
                    ``(I) Prohibition on payment for certain items 
                furnished using a drop shipment.--
                            ``(i) In general.--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.
                            ``(ii) Items described.--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.
                            ``(iii) Drop shipment defined.--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.''.
    (b) Additional Practitioners Exempt From Competitive Acquisition.--
Section 1847(a)(7)(A)(i) of the Social Security Act (42 U.S.C. 1395w-
3(a)(7)(A)(i)) is amended--
            (1) by inserting ``, physical therapist, occupational 
        therapist, orthotist, prosthetist,'' after ``by a physician''; 
        and
            (2) by striking ``the physician's'' each place it appears 
        and inserting ``such physician's'' in each such place.
    (c) Ensuring Beneficiary Access to Replacement Custom-Fitted 
Orthotics and Custom-Fabricated Orthotic Devices.--Section 
1834(h)(1)(G) of the Social Security Act (42 U.S.C. 1395m(h)(1)(G)) is 
amended--
            (1) in the heading, by inserting ``, custom-fitted 
        orthotics, custom-fabricated orthotics,'' after ``Replacement 
        of prosthetic devices''; and
            (2) 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,''.
    (d) Regulations.--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.
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