H.R. 4475: Medicare Orthotics and Prosthetics Patient-Centered Care Act

This bill, known as the Medicare Orthotics and Prosthetics Patient-Centered Care Act, aims to enhance the protection and care of Medicare beneficiaries who require orthotic and prosthetic services. It proposes several significant changes to existing Medicare policies regarding these services.

Key Provisions

1. Payment Restrictions on Drop Shipments

The bill prohibits Medicare from paying for orthotic and prosthetic items that are delivered directly to a beneficiary (known as "drop shipments") without the beneficiary receiving proper training from a qualified practitioner. This means that if a beneficiary has not been educated on how to fit, adjust, care for, and use their orthotic or prosthetic device, Medicare will not cover the expense. This aims to ensure that beneficiaries are appropriately informed and trained before receiving such equipment.

2. Inclusion of Additional Practitioners

The legislation expands the definition of practitioners who can furnish orthotic and prosthetic items to include not just physicians but also physical therapists, occupational therapists, orthotists, and prosthetists. This change is intended to provide beneficiaries with more access to qualified professionals who can assist them with their needs.

3. Custom Orthotics Access

The bill ensures that Medicare beneficiaries have access to replacement custom-fitted orthotics and custom-fabricated orthotic devices. It explicitly updates the Medicare regulations to include these types of devices, therefore allowing individuals to receive necessary support when their current orthotics are worn out or inadequate.

4. Regulatory Implementation Timeline

The Secretary of Health and Human Services is required to establish final regulations to implement these amendments within one year after the bill becomes law. This ensures that the new policies are promptly put into practice.

Summary of Goals

The primary goals of this bill are to enhance beneficiary safety and care regarding orthotic and prosthetic devices, reduce instances of fraud and abuse within the Medicare system for these items, and ensure that beneficiaries receive effective and patient-centered services.

Relevant Companies

None found