House bill would improve access to orthotic devices under Medicare

On June 23rd, Representatives G.T. Thompson (R-PA), Mike Thompson (D-CA), Brett Guthrie (R-KY), and Angie Craig (D-MN) introduced the Medicare Orthotics and Prosthetics Patient-Centered Care Act (H.R. 4315) in the U.S. House of Representatives. This legislation would ensure that Medicare beneficiaries are able to access the orthotic and prosthetic devices they need.

The bill does this through three major provisions:

• Ensure that Medicare beneficiaries have timely access to a replacement custom-fitted and custom-fabricated orthosis if an ordering physician determines that a replacement orthosis is necessary due to a change in the physiological condition of the patient, there has been an irreparable change in the condition of the orthosis, or the cost of repairs would be excessive. Under current Medicare law, Medicare beneficiaries often wait years before the Medicare program will cover a replacement orthosis, regardless of whether the orthosis is medically necessary.
• Put into law an exemption from competitive bidding, for occupational therapy practitioners, physical therapists, orthotists and prosthetists, and physicians when providing off-the-shelf (OTS) orthoses, to Medicare beneficiaries, in the course of their practice, allowing these providers to furnish OTS orthoses without a competitive bidding contract.
• Reduce the likelihood of waste, fraud, and abuse by prohibiting “drop-shipment” of all custom-fitted and custom-fabricated orthoses and all prostheses to a Medicare beneficiary’s home without any clinical intervention by a provider or supplier. This would result in significant cost-savings to the Medicare program while protecting patient access to clinical assessments, fittings, adjustments, and other related clinical care.

AOTA has worked closely with the American Orthotic and Prosthetic Association (AOPA), the American Physical Therapy Association (APTA), and the American Society of Hand Therapists (ASHT) in helping to draft this legislation. We greatly appreciate the support of our Congressional champions who are dedicated to ensuring access to orthotic and prosthetic devices and ending the fraudulent provision of these devices.