Medicare Orthotics and Prosthetics Patient-Centered Care Act
Sponsored By: Representative Thompson (PA)
Introduced
Summary
Curb improper payments from drop shipments. This bill would change Medicare rules for orthotics and prosthetics to block certain drop-ship payments and to secure patient access to replacement custom devices. It would also expand which clinicians are exempt from competitive acquisition and require HHS to issue final regulations within one year.
Show full summary
- Families and patients: Would ensure beneficiary access to replacement custom-fitted and custom-fabricated orthotics by adding those replacements into Medicare’s statutory coverage rules.
- Providers and clinicians: Would broaden the competitive-acquisition exemption to include physical therapists, occupational therapists, orthotists, and prosthetists so they can furnish certain orthotics and prosthetics without that procurement process.
- Medicare program and taxpayers: Would prohibit payment for orthotics and prosthetics sent by drop shipment when a patient has not received training from a qualified practitioner, aiming to curb improper payments. It would also require the Secretary of Health and Human Services to finalize implementing regulations within 1 year of enactment.
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Bill Overview
Analyzed Economic Effects
4 provisions identified: 3 benefits, 1 costs, 0 mixed.
Medicare coverage for replacement custom orthotics
The bill would clearly include replacement custom-fitted and custom-fabricated orthotics under Medicare’s replacement rules. If you need a covered replacement custom orthotic, it would be recognized for coverage. This could lower your out-of-pocket costs when a replacement is needed.
No Medicare pay for drop-shipped orthotics
The bill would stop Medicare from paying for certain orthotics and prosthetics that are drop-shipped to you. A drop shipment means the item is sent to you before you get training from a qualified practitioner on fit, care, and use. It applies to items with HCPCS codes not paid under Medicare’s section 1847 program. Supplies are not affected. This would start on the first day of the first year after enactment.
More clinicians exempt from bidding rules
The bill would add physical therapists, occupational therapists, orthotists, and prosthetists to an exemption from Medicare’s competitive bidding rules for some items. These clinicians could furnish certain orthotics and prosthetics without going through the bidding program. Patients could have more places to get care, but payment rates would not change in this bill.
One-year deadline for Medicare rules
HHS would have to issue final rules within one year after enactment to carry out these changes. This could speed clear guidance for patients, clinicians, and suppliers.
Sponsors & CoSponsors
Sponsor
Thompson (PA)
PA • R
Cosponsors
Thompson (CA)
CA • D
Sponsored 7/17/2025
Bilirakis
FL • R
Sponsored 7/17/2025
Dingell
MI • D
Sponsored 7/17/2025
Ruiz
CA • D
Sponsored 7/21/2025
Davis (NC)
NC • D
Sponsored 7/23/2025
Meuser
PA • R
Sponsored 8/5/2025
Lawler
NY • R
Sponsored 8/5/2025
Crow
CO • D
Sponsored 8/8/2025
Brownley
CA • D
Sponsored 8/26/2025
Gottheimer
NJ • D
Sponsored 8/26/2025
Davids (KS)
KS • D
Sponsored 8/26/2025
Del. Norton, Eleanor Holmes [D-DC-At Large]
DC • D
Sponsored 9/2/2025
Perez
WA • D
Sponsored 9/2/2025
Jayapal
WA • D
Sponsored 9/2/2025
Bost
IL • R
Sponsored 9/3/2025
Craig
MN • D
Sponsored 9/3/2025
Balderson
OH • R
Sponsored 9/19/2025
Vindman
VA • D
Sponsored 9/26/2025
McGovern
MA • D
Sponsored 9/30/2025
Sewell
AL • D
Sponsored 10/10/2025
Thanedar
MI • D
Sponsored 11/4/2025
Cohen
TN • D
Sponsored 11/4/2025
Harder (CA)
CA • D
Sponsored 11/4/2025
Kelly (PA)
PA • R
Sponsored 12/9/2025
Neguse
CO • D
Sponsored 12/23/2025
Murphy
NC • R
Sponsored 2/3/2026
Fitzpatrick
PA • R
Sponsored 2/20/2026
Roll Call Votes
No roll call votes available for this bill.
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