119-hr4475

[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[H.R. 4475 Introduced in House

    (IH) ]

<DOC>

119th CONGRESS
 1st Session
 H. R. 4475

 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.

_______________________________________________________________________

 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.
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