This act enhances protections for Medicare beneficiaries receiving orthotic and prosthetic care by ensuring required training accompanies direct shipments and expanding exemptions within competitive acquisition programs.
Glenn Thompson
Representative
PA-15
The Medicare Orthotics and Prosthetics Patient-Centered Care Act aims to enhance protections for Medicare beneficiaries receiving custom braces and artificial limbs. This bill ensures that payment will not be made for certain devices shipped directly to a patient without required training from a qualified practitioner. Additionally, it expands exemptions from competitive bidding for certain providers and clarifies access to replacement custom orthotic devices.
Medicare Bill Stops Direct Shipping of Custom Braces Without Training, Expands Provider Exemptions
The “Medicare Orthotics and Prosthetics Patient-Centered Care Act” is aiming to tighten up the rules around how Medicare pays for custom braces (orthotics) and artificial limbs (prosthetics). The core of this bill is a focus on patient safety and proper use. Starting one year after the bill becomes law, Medicare will generally stop paying for certain custom devices if they are shipped directly to the beneficiary without the person receiving proper training and education from a qualified practitioner first. This means no more dropping a complex, custom-fitted item on your doorstep without someone walking you through how to use, adjust, and care for it.
No Training, No Pay: The Safety Check
This new rule, found in Section 2, is a direct response to concerns about complex medical equipment being mailed out without any guarantee that the patient knows how to use it safely or effectively. Think about it: if you need a custom leg brace to walk, getting it in a box with an instruction manual isn't going to cut it. You need a professional to ensure the fit is right and you know how to manage it. This provision mandates that a qualified practitioner must provide training on the item's fit, adjustment, care, and use before Medicare pays the bill. While this is a huge win for safety and better outcomes—nobody wants to waste time and money on a device that doesn't fit—it does introduce a potential bottleneck. For beneficiaries in rural areas, or those with limited mobility, scheduling this mandatory training could delay access to the device they desperately need.
Leveling the Playing Field for Practitioners
The bill also makes a significant change to the competitive bidding program for durable medical equipment. Previously, physicians were often exempt from these rules, meaning they could provide certain equipment without being subjected to the competitive acquisition process that aims to lower costs. This Act expands that exemption list to include physical therapists, occupational therapists, orthotists, and prosthetists. Essentially, these specialized professionals are now treated the same as physicians regarding competitive acquisition. For orthotists and prosthetists, who are the experts in fitting these custom devices, this change helps ensure they can continue providing care without unnecessary administrative hurdles, which should ultimately benefit patient choice.
Clarity for Replacement Parts
Finally, the legislation clears up a common headache for people relying on custom devices: replacement coverage. The bill updates the rules to explicitly include custom-fitted orthotics and specific custom-fabricated orthotics under the same replacement rules that apply to prosthetic devices. This matters because custom braces wear out, get damaged, or need replacing as a patient's condition changes. This change ensures that if you have a custom orthotic, you have a clear path to getting a replacement covered by Medicare, just like you would for an artificial limb. The Secretary of Health and Human Services has one year to issue the final rules to put all these changes into effect.