New Medicare Bill Bans 'Drop Shipping' for Custom Braces and Limbs to Ensure Patient Training

The “Medicare Orthotics and Prosthetics Patient-Centered Care Act” is designed to tighten up how Medicare pays for custom medical equipment, specifically artificial limbs (prosthetics) and custom braces (orthotics). Basically, this bill is focused on patient safety and making sure that when you get a complex piece of gear, you actually know how to use it.

No More Mystery Boxes: Stopping Untrained Shipments

The biggest change here is the crackdown on what the bill calls “drop shipments” for certain custom orthotics and prosthetics. Starting one year after the law passes, Medicare will not pay for specific custom devices if they are shipped directly to the patient without hands-on training or education from a qualified professional. Think of it this way: if you need a custom leg brace that costs thousands of dollars and needs precise fitting, Medicare won't pay if it just shows up on your porch like a package from Amazon. You must first get training on how to properly fit, adjust, care for, and use the device from someone qualified, like a certified prosthetist or physical therapist. This is a huge win for patient safety, as it ensures people aren't trying to self-fit complex medical devices, which can lead to injury or improper use that makes the device useless. This rule applies to specific billing codes that are not part of the competitive bidding program.

Streamlining Access with More Qualified Eyes

Another practical change aims to speed up the process for getting this equipment. Currently, the rules often lean heavily on physicians to certify the medical necessity for these devices. This bill expands the list of professionals who can be involved in certifying the need for the equipment. Alongside physicians, the list now explicitly includes physical therapists, occupational therapists, orthotists, and prosthetists. For a busy person needing a new brace, this means less time waiting for a single doctor’s sign-off and more options for getting the necessary evaluation, which should smooth out the process considerably.

Clarifying Coverage for Replacement Gear

The bill also cleans up some confusing language around replacement devices. It explicitly ensures that replacement custom-fitted orthotics and custom-fabricated orthotic devices are treated the same way as replacement prosthetic limbs under existing Medicare rules. If you’ve ever had to deal with insurance replacing a vital piece of equipment, you know that clarity is everything. This provision means that if your custom brace breaks or wears out, the process for getting a replacement should be straightforward and covered under established replacement guidelines, rather than getting caught in a bureaucratic loophole.

The Real-World Tradeoff

For most Medicare beneficiaries, this bill is a net positive, focusing on better outcomes and clearer rules. However, there is a minor potential snag: while mandatory training is essential for safety, it might slow down the delivery process slightly, especially for people in rural areas where access to qualified orthotists or prosthetists might be limited. DME (Durable Medical Equipment) suppliers who currently rely on simple shipping for these items will have to change their business model to ensure this mandatory training component is met before they can bill Medicare. The Secretary of Health and Human Services has one year to put the final rules in place, so the clock is ticking on implementation.