HR 4475

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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.

Be it enacted by the Senate and House of Representatives of the United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

This Act may be cited as the “Medicare Orthotics and Prosthetics Patient-Centered Care Act”.

SEC. 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. <all>