Medicare Orthotics and Prosthetics Patient-Centered Care Act
Sponsored By: Senator Mark Warner
Introduced
Summary
Tying Medicare payment for orthotics and prosthetics to patient training and stopping direct drop shipments. The bill would also expand which practitioners are exempt from the competitive acquisition program, guarantee replacement coverage for custom-fitted and custom-fabricated orthotics, and require the Department of Health and Human Services to issue final rules within one year.
Show full summary
- Beneficiaries: Would qualify for Medicare payment only for orthotics and prosthetics that come with fitting, adjustment, care, and use training from a qualified practitioner. It would also permit replacement of custom-fitted and custom-fabricated orthotics described as artificial limbs.
- Practitioners: Adds physical therapists, occupational therapists, orthotists, and prosthetists to the group exempted from the competitive acquisition regime so they are treated like physicians for that exemption.
- Suppliers and program integrity: Prohibits Medicare payment for items shipped directly to patients who have not received practitioner training, a change aimed at reducing fraud, waste, and abuse.
- Regulations: Requires the HHS Secretary to publish final implementing regulations within one year of enactment.
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Bill Overview
Analyzed Economic Effects
4 provisions identified: 3 benefits, 1 costs, 0 mixed.
Medicare covers replacement orthotics
If enacted, Medicare would allow replacement of custom-fitted orthotics and some custom-fabricated orthotics when they are described as artificial limbs. The amendment text does not specify an effective date.
Medicare stops payments for drop-shipped devices
If enacted, Medicare would not pay for orthotics and prosthetics sent directly to a patient who has not received practitioner training. This rule would start on the first day of the first year after enactment.
More providers exempt from purchasing rules
If enacted, physical therapists, occupational therapists, orthotists, and prosthetists would be added to the list of practitioners exempt from a Medicare competitive acquisition rule. This is mainly a procedural change for those providers.
HHS must issue rules within one year
If enacted, HHS would have to publish final regulations implementing these changes within one year after enactment. The deadline clarifies how the other rules would be applied but does not itself change coverage or payment amounts.
Sponsors & CoSponsors
Sponsor
Mark Warner
VA • D
Cosponsors
Steve Daines
MT • R
Sponsored 7/17/2025
Roll Call Votes
No roll call votes available for this bill.
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