[Congressional Bills 118th Congress]
[From the U.S. Government Publishing Office]
[H.R. 4315 Introduced in House (IH)]
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118th CONGRESS
1st Session
H. R. 4315
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
June 23, 2023
Mr. Thompson of Pennsylvania (for himself, Mr. Thompson of California,
Mr. Guthrie, Ms. Craig, and Mr. Sessions) 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.--
(1) In general.--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 shall be made
under this subsection for an item described in
clause (ii) furnished to an individual via a
drop shipment.
``(ii) Items described.--This items
described in this clause are the following:
``(I) A prosthesis (as defined in
subparagraph (H)(4)(B)), 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 delivered by
drop shipment.
``(iii) Drop shipment defined.--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)).''.
(2) Effective date.--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.
(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 inserting ``, physical therapist, occupational
therapist, orthotist, prosthetist'' after ``the physician's''
in each place such term occurs.
(c) Ensuring Beneficiary Access to Replacement Custom-Fitted
Orthotic Devices 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 orthotic
devices, custom-fabricated orthotic devices,'' after
``Replacement of prosthetic devices''; and
(2) in clause (i), by inserting ``, replacement of custom-
fitted orthotic devices, replacement of custom-fabricated
orthotic devices,'' after ``which are artificial limbs,''.
(d) Updating Definitions of Orthotics and Prosthetics.--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''.
(e) 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
Act.
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