H.R. 4475

119 HR 4475 IH: Medicare Orthotics and Prosthetics Patient-Centered Care Act
 U.S. House of Representatives
 2025-07-17
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 I  119th CONGRESS  1st Session  H. R. 4475  IN THE HOUSE OF REPRESENTATIVES   July 17, 2025   Mr. Thompson of Pennsylvania  (for himself,  Mr. Thompson of California ,  Mr. Bilirakis , and  Mrs. Dingell ) introduced the following bill; which was referred to the  Committee on Energy and Commerce , and in addition to the Committee on  Ways and Means , for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned   A BILL
To amend title XVIII of the Social Security Act to protect beneficiaries with limb loss and other orthopedic conditions by providing access to appropriate, safe, effective, patient-centered orthotic and prosthetic care, to reduce fraud, waste, and abuse with respect to orthotics and prosthetics, and for other purposes.
1.
Short title
This Act may be cited as the   Medicare Orthotics and Prosthetics Patient-Centered Care Act  .
2.
Increasing protections for Medicare beneficiaries receiving orthotic and prosthetic care
(a)
Prohibition on payment for items delivered by drop shipment
Section 1834(h)(1) of the Social Security Act ( 42 U.S.C. 1395m(h)(1) ) is amended by adding at the end the following new subparagraph:
(I)
Prohibition on payment for certain items furnished using a drop shipment
(i)
In general
No payment may be made under this subsection for an item described in clause (ii) furnished to an individual via a drop shipment on or after the first day of the first year beginning after the date of the enactment of this subparagraph.
(ii)
Items described
The items described in this clause are orthotics and prosthetics, not including supplies for such orthotics and prosthetics, that are identified by HCPCS codes for which payment is not made under section 1847.
(iii)
Drop shipment defined
In this subparagraph, the term  drop shipment  means, with respect to an item described in clause (ii), the direct shipment of such item to an individual who has not received training or education from a qualified practitioner (as defined in subparagraph (F)(iii)) on the fitting and adjustment, care, and use of such item.
 .
(b)
Additional practitioners exempt from competitive acquisition
Section 1847(a)(7)(A)(i) of the Social Security Act ( 42 U.S.C. 1395w–3(a)(7)(A)(i) ) is amended—
(1)
by inserting  , physical therapist, occupational therapist, orthotist, prosthetist,  after  by a physician ; and
(2)
by striking  the physician’s  each place it appears and inserting  such physician’s  in each such place.
(c)
Ensuring beneficiary access to replacement custom-Fitted orthotics and custom-Fabricated orthotic devices
Section 1834(h)(1)(G) of the Social Security Act ( 42 U.S.C. 1395m(h)(1)(G) ) is amended—
(1)
in the heading, by inserting  ,
 custom-fitted orthotics, custom-fabricated orthotics ,  after
Replacement of prosthetic devices  ; and
(2)
in clause (i), by inserting  replacement of custom-fitted orthotics, replacement of items of custom-fabricated orthotics described in subparagraph (F)(ii),  after  which are artificial limbs, .
(d)
Regulations
Not later than 1 year after the date of the enactment of this Act, the Secretary of Health and Human Services shall promulgate final regulations to implement the amendments made by this section.