[Congressional Bills 117th Congress]
[From the U.S. Government Publishing Office]
[H.R. 1990 Introduced in House (IH)]
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117th CONGRESS
1st Session
H. R. 1990
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
March 17, 2021
Mr. Thompson of California (for himself, Mr. Guthrie, Mr. Thompson of
Pennsylvania, and Mr. Butterfield) 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 BENEFICIARIES RECEIVING ORTHOTIC AND
PROSTHETIC CARE UNDER THE MEDICARE PROGRAM.
(a) Distinguishing Orthotists and Prosthetists From Suppliers of
Durable Medical Equipment and Supplies.--Section 1834 of the Social
Security Act (42 U.S.C. 1395m) is amended--
(1) in subsection (j)(5), by striking subparagraph (C) and
redesignating the subsequent subparagraphs accordingly; and
(2) by adding at the end the following new subsection:
``(x) Requirements for Orthotists and Prosthetists.--
``(1) Issuance and renewal of supplier number.--
``(A) Payment.--
``(i) In general.--No payment may be made
under this part to an orthotic or prosthetic
supplier unless such orthotic or prosthetic
supplier obtains (and renews at such intervals
as the Secretary may require) a supplier
number.
``(ii) Clarification regarding providers
under part a.--Nothing in clause (i) shall
prohibit a provider otherwise permitted to
receive payment for orthotics and prosthetics
under part A from continuing to receive payment
under such part without interruption.
``(B) Standards for possessing a supplier number.--
An orthotic or prosthetic supplier may only obtain a
supplier number if the supplier meets standards
prescribed by the Secretary that include requirements
that the orthotic or prosthetic supplier (and, where
applicable, the orthotist or prosthetist)--
``(i) licensure and accreditation--
``(I) complies with all applicable
State and Federal licensure and
regulatory requirements; and
``(II) acquires accreditation from
the American Board for Certification in
Orthotics, Prosthetics and Pedorthics,
Inc. or the Board of Certification/
Accreditation, International, or other
accreditation entity that the Secretary
determines has standards that are
equivalent to the standards of such
Boards;
``(ii) maintains a physical facility on an
appropriate site;
``(iii) has proof of appropriate liability
insurance; and
``(iv) meets such other requirements as the
Secretary shall specify.
``(C) Prohibition against multiple supplier
numbers.--The Secretary may not issue more than one
supplier number to any orthotic or prosthetic supplier
unless the Secretary finds that the issuance of more
than one number is appropriate to identify other
entities under the ownership or control of the orthotic
or prosthetic supplier.
``(2) Order for orthotics or prosthetics.--
``(A) Information provided by orthotists and
prosthetists on detailed written orders for orthotics
and prosthetics.--An orthotist or prosthetist may
distribute to physicians, physician assistants, nurse
practitioners, clinical nurse specialists, or
individuals entitled to benefits under this part, a
detailed written order for orthotics or prosthetics (as
defined in paragraph (5)) for commercial purposes that
contains the following information:
``(i) The identification of--
``(I) the orthotic or prosthetic
supplier; and
``(II) the individual to whom the
orthotics or prosthetics are furnished.
``(ii) The identification of the treating
physician, physician assistant, nurse
practitioner, or clinical nurse specialist.
``(iii) A description of the orthotics or
prosthetics ordered.
``(iv) The date of the order described in
this subparagraph.
``(B) Information on coding and descriptors of
components provided.--If an orthotist or prosthetist
distributes a detailed written order for orthotics or
prosthetics described in subparagraph (A), the
orthotist or prosthetist shall also list on the order
the summary descriptors of the items and services being
recommended prior to submission of the order to the
treating physician for approval.
``(C) Signature by treating physician.--A detailed
written order for orthotics or prosthetics described in
subparagraph (A) shall be signed by the treating
physician.
``(3) Limitation on patient liability.--Except as provided
in paragraph (4), if an orthotist or prosthetist--
``(A) furnishes an orthosis or prosthesis to a
beneficiary for which no payment may be made under this
part; or
``(B) subject to section 1879, furnishes an
orthosis or prosthesis to a beneficiary for which
payment is denied under section 1862(a)(1),
any expenses incurred for the orthosis or prosthesis furnished
to an individual by the orthotist or prosthetist not on an
assigned basis shall be the responsibility of such orthotist or
prosthetist. The individual shall have no financial
responsibility for such expenses and the orthotist or
prosthetist shall refund on a timely basis to the individual
(and shall be liable to the individual for) any amounts
collected from the individual for such items and services. The
provisions of subsection (a)(18) shall apply to refunds
required under the previous sentence in the same manner as such
provisions apply to refunds under such subsection.
``(4) Patient liability.--If an orthotist or prosthetist
furnishes an orthosis or prosthesis to a patient for which
payment is denied in advance under subsection (a)(15), expenses
incurred for such orthosis or prosthesis furnished to the
individual by the orthotist or prosthetist shall be the
responsibility of the individual.
``(5) Definitions.--In this subsection:
``(A) Detailed written order for orthotics or
prosthetics.--
``(i) In general.--The term `detailed
written order for orthotics or prosthetics'
means a form or other document prepared by an
orthotist or prosthetist and signed by the
physician (as defined by section 1861(r)) that
contains information required by the Secretary
to show that an orthosis or prosthesis is
reasonable and necessary for the treatment of
an illness or injury or to improve the
functioning of a malformed body member.
``(ii) Clarification.--The detailed written
order for orthotics or prosthetics shall not be
considered alone for purposes of determining
the reasonableness, medical necessity, and
functional level (applicable to prosthetics) of
orthotics and prosthetics.
``(B) Orthotics and prosthetics.--The term
`orthotics and prosthetics' has the meaning given that
term in section 1834(h)(4)(C).
``(C) Orthotist or prosthetist.--The term
`orthotist or prosthetist' means an individual who is
specifically trained and educated in the provision of,
and patient care management related to, prosthetics and
custom-fabricated or custom-fit orthotics, and--
``(i) in the case of a State that provides
for the licensing of orthotists and
prosthetists, is licensed by the State in which
the orthotics or prosthetics were supplied; or
``(ii) in the case of a State that does not
provide for the licensing of orthotists and
prosthetists, is certified by the American
Board for Certification in Orthotics,
Prosthetics and Pedorthics, Inc. or by the
Board of Certification/Accreditation,
International, or is certified and approved by
an entity that the Secretary determines has
certification and approval standards that are
essentially equivalent to the certification and
approval standards of such Boards.''.
(b) Prohibiting Payment for Certain Orthotics and Prosthetics.--
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) Special payment rules for orthotics or
prosthetics.--
``(i) In general.--No payment shall be made
under this subsection for--
``(I) a prosthesis (excluding
prosthetic supplies) that is delivered
by drop shipment;
``(II) a custom-fabricated or
custom-fitted orthosis (excluding
orthotic supplies) described in
subparagraph (F)(ii) that is delivered
by drop shipment; and
``(III) an orthotic item that is
not otherwise competitively bid that is
delivered by drop shipment.
``(ii) Drop shipment defined.--In this
subparagraph, the term `drop shipment' means
the shipping of an orthosis or prosthesis to a
beneficiary without receiving from a trained,
educated, and certified or licensed health care
practitioner, orthotist, or prosthetist direct
patient care with respect to assessing,
adjusting, and training in the care and use of
the orthosis or prosthesis.''.
(c) Standardizing the Definitions of Orthotics and Prosthetics.--
Section 1834(h)(4) of the Social Security Act (42 U.S.C. 1395m(h)(4))
is amended--
(1) in subparagraph (B), by striking at the end ``and'';
(2) in subparagraph (C)--
(A) 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''; and
(B) by striking the period at the end and inserting
``; and''; and
(3) by inserting after subparagraph (C), as amended by
paragraph (2), the following new subparagraph:
``(D) the terms `prosthetics' and `prostheses'
refer to a device (including the clinical services
associated with such device) that replaces all or part
of a limb.''.
(d) Limitation of Competitive Acquisition for Off-the-Shelf
Orthotics.--Section 1847(a) of the Social Security Act (42 U.S.C.
1395w-3(a)) is amended--
(1) in paragraph (2)(C), by inserting ``by the patient (and
not by another person)'' after ``minimal self-adjustment''; and
(2) in paragraph (7)(A)(i)--
(A) by inserting ``, orthotist or prosthetist (as
defined in section 1834(x)(5)(C)),'' after ``by a
physician'';
(B) by inserting ``, orthotist's or
prosthetist's,'' after ``to the physician's''; and
(C) by inserting ``, orthotist's or
prosthetist's,'' after ``of the physician's''.
(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 provisions of, and
amendments made by, this Act.
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