Prosthetic Categories

Bill Introduced to Protect Medicare Beneficiaries’ Access to Orthotics, Prosthetics

    In the past few years, there have been reports of prosthetic users in the US falling victim to fraudulent activities, including receiving non-functional devices from drop shippers. To address this problem, Senators Mark Warner, D-Va. and Steve Daines, R-Mont. have put forth a bill prohibiting “drop shipping” custom orthoses and prostheses to Medicare beneficiaries, among other measures.

     A bipartisan bill aims to protect Medicare beneficiaries' access to orthotics and prosthetics.

    The Medicare Orthotics and Prosthetics Patient-Centered Care Act (SB 3977; H.R. 5315) aims to improve Medicare beneficiaries’ access to high-quality orthotics and prosthetics. It plans to achieve this by combatting fraud, increasing the availability of replacement devices, and eliminating regulations that unfairly impact orthotists and prosthetists.

    In particular, the Medicare Orthotics and Prosthetics Patient-Centered Care Act aims to:

    • Quash fraud by disallowing the drop shipping of devices that must be fitted to a patient.

    • Grant orthotists and prosthetists exemptions from stringent policies that apply to them but not to other healthcare providers in order to sell non-fitted devices.

    • Ensure that Medicare beneficiaries have prompt access to a replacement device if a provider deems it necessary due to changes in the patient’s condition, the device’s condition, or excessive repair costs.

    Most orthotics and prosthetics are custom-made and require the expertise of a certified orthotist or prosthetist. However, Medicare’s current practice is to reimburse custom orthoses and prostheses that are drop-shipped or shipped directly to the consumer without the input of a medical professional. This can lead to potential waste and fraud.

    Additionally, Medicare coverage doesn’t include replacements for orthotics or prosthetics that are still within the expected time of use, even if they are completely damaged or the patient’s condition has changed. The bill aims to close this loophole and allow coverage for replacements under certain conditions.

    Moreover, the bill includes a change that exempts certified orthotists and prosthetists from sending patients to a provider with a competitive bidding license. This change removes unnecessary barriers to patient care and ensures that orthotists and prosthetists aren’t subject to overly strict requirements.

    In a press release, Eve Lee, MBA CAE, Executive Director of the American Orthotic and Prosthetic Association (AOPA), emphasized AOPA’s longstanding advocacy for Medicare to safeguard patients’ access to high-quality care. If this legislation is approved, it will not only protect patients but also combat costly fraudulent practices within the Medicare system.

    As of this writing, 44 organizations have supported this bill. The bill's text can be read here.