[Congressional Bills 106th Congress]
[From the U.S. Government Publishing Office]
[H.R. 5156 Introduced in House (IH)]







106th CONGRESS
  2d Session
                                H. R. 5156

To amend title XVIII of the Social Security Act to establish standards 
     for payment under the Medicare Program for certain orthotic, 
                   prosthetic, and pedorthic devices.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                           September 12, 2000

  Mrs. McCarthy of New York introduced the following bill; which was 
referred to the Committee on 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 establish standards 
     for payment under the Medicare Program for certain orthotic, 
                   prosthetic, and pedorthic devices.

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

SECTION 1. STANDARDS REGARDING PAYMENT FOR CERTAIN ORTHOTICS, 
              PROSTHETICS, AND PEDORTHICS.

    (a) Standards.--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
                    ``(F) Establishment of standards for certain 
                items.--
                            ``(i) In general.--No payment shall be made 
                        for an applicable item unless the item is 
                        provided by a qualified practitioner or a 
                        qualified supplier under the system established 
                        by the Secretary under clause (iii). For 
                        purposes of the preceding sentence, if a 
                        qualified practitioner or a qualified supplier 
                        contracts with an entity to provide an 
                        applicable item, then no payment shall be made 
                        for such item unless the entity is also a 
                        qualified supplier.
                            ``(ii) Definitions.--In this subparagraph:
                                    ``(I) Applicable item.--The term 
                                `applicable item' means orthotics, 
                                prosthetics, and pedorthics that 
                                require education, training, and 
                                experience to dispense such item as a 
                                part of a treatment plan.
                                    ``(II) Qualified practitioner.--The 
                                term `qualified practitioner' means a 
                                physician or health care professional 
                                who--
                                            ``(aa) is specifically 
                                        trained and educated to provide 
                                        or manage the provision of 
                                        custom-designed, fabricated, 
                                        modified, and fitted orthotics, 
                                        prosthetics, and pedorthics, 
                                        and is certified by the 
                                        American Board for 
                                        Certification in Orthotics and 
                                        Prosthetics, Inc., to dispense 
                                        orthotics, prosthetics, or 
                                        pedorthic devices, is 
                                        specifically trained and 
                                        educated to provide or manage 
                                        the provision of custom-
                                        designed, fabricated, modified, 
                                        and fitted pedorthics and is 
                                        certified by the Board for 
                                        Certification in Pedorthics to 
                                        dispense pedorthic devices, or 
                                        is credentialed and approved by 
                                        a program that the Secretary 
                                        determines, in consultation 
                                        with appropriate experts in 
                                        orthotics, prosthetics, and 
                                        pedorthics, has training and 
                                        education standards that are 
                                        necessary to provide applicable 
                                        items;
                                            ``(bb) is licensed in 
                                        orthotics, prosthetics, or 
                                        pedorthics by the State in 
                                        which the applicable item is 
                                        supplied; or
                                            ``(cc) has completed at 
                                        least 10 years of practice in 
                                        the provision of applicable 
                                        items.
                                    ``(III) Qualified supplier.--The 
                                term `qualified supplier' means any 
                                entity that is--
                                            ``(aa) accredited by the 
                                        American Board for 
                                        Certification in Orthotics and 
                                        Prosthetics, Inc.;
                                            ``(bb) accredited by the 
                                        Board for Certification in 
                                        Pedorthics, Inc., to dispense 
                                        pedorthic devices; or
                                            ``(cc) accredited and 
                                        approved by a program that the 
                                        Secretary determines has 
                                        accreditation and approval 
                                        standards that are essentially 
                                        equivalent to those of such 
                                        Boards.
                            ``(iii) System.--The Secretary, in 
                        consultation with appropriate experts in 
                        orthotics, prosthetics, and pedorthics, shall 
                        establish a system under which the Secretary 
                        shall--
                                    ``(I) determine which items are 
                                applicable items and formulate a list 
                                of such items;
                                    ``(II) review the applicable items 
                                billed under the coding system 
                                established under this title; and
                                    ``(III) limit payment for 
                                applicable items pursuant to clause 
                                (i).''.
    (b) Revision of Definition of Orthotics.--Section 1861(s)(9) of the 
Social Security Act (42 U.S.C. 1395x(s)(9)) is amended by inserting 
``(including such braces that are used in conjunction with, or as 
components of, other medical or nonmedical equipment when provided by a 
qualified practitioner (as defined in subclause (II) of section 
1834(h)(1)(F)(ii)) or a qualified supplier (as defined in subclause 
(III) of such section)'' after ``braces''.
    (c) Definition of Pedorthic Devices.--
            (1) In general.--Section 1861(s) of the Social Security Act 
        (42 U.S.C. 1395x(s)) is amended--
                    (A) by redesignating paragraphs (16) and (17) as 
                paragraphs (17) and (18), respectively;
                    (B) by striking ``and'' at the end of paragraph 
                (14);
                    (C) by striking the period at the end of paragraph 
                (15) and inserting ``; and''; and
                    (D) by inserting after paragraph (15) the following 
                new paragraph:
            ``(16)(A) pedorthic devices consisting of therapeutic 
        shoes, shoe modifications made for therapeutic purposes, 
        partial foot prostheses, and foot orthoses for use from the 
        ankle and below, but not including non-therapeutic, 
        accommodative inlays and non-therapeutic accommodative footwear 
        (regardless of method of manufacture) or prefabricated foot 
        care products; and
            ``(B) in subparagraph (A)--
                    ``(i) a pedorthic device is therapeutic if the 
                device addresses a medical condition and is prescribed 
                by a physician or practitioner; and
                    ``(ii) an inlay or footwear is accommodative is an 
                inlay or footwear that is designed with a primary goal 
                of conforming to an individual's anatomy.''.
            (2) Conforming amendments.--Sections 1864(a), 
        1902(a)(9)(C), and 1915(a)(1)(B)(ii)(I) of such Act (42 U.S.C. 
        1395aa(a), 1396a(a)(9)(C), and 1396n(a)(1)(B)(ii)(I)) are each 
        amended by striking ``paragraphs (16) and (17)'' each place it 
        appears and inserting ``paragraphs (17) and (18)''.
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