Medicare Orthotics and Prosthetics Patient-Centered Care Act
- Bill Number
- H.R. 4475
- Origin Chamber
- House
- Congress
- 119th Congress, Session 1
- Policy Area
- Health
- Status
- Introduced
- Latest Action
- 2025-07-17: 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.
- Last Updated
- 2026-05-08T08:06:33Z
AI-Generated Summary
Purpose of the Legislation
The Medicare Orthotics and Prosthetics Patient-Centered Care Act (H.R. 4475) aims to protect Medicare beneficiaries who have lost limbs or have other orthopedic conditions. It seeks to ensure they receive safe, effective, and personalized orthotic (devices that support or correct body alignment, like braces) and prosthetic (artificial limbs) care. The bill also intends to cut down on fraud, waste, and abuse in the delivery of these devices under Medicare.
Key Provisions
- Ban on Drop Shipments for Certain Devices: Medicare will not pay for orthotics or prosthetics delivered directly to patients via "drop shipment" starting the year after the bill's enactment. Drop shipment means sending the device straight to the patient without hands-on training from a qualified practitioner (such as an orthotist or prosthetist) on how to fit, adjust, care for, and use it. This applies to devices coded under HCPCS (a system for billing medical items) that are not part of Medicare's competitive bidding process.
- Expanded Exemptions from Competitive Bidding: Physical therapists, occupational therapists, orthotists, and prosthetists are now exempt from Medicare's competitive acquisition rules for supplying certain off-the-shelf orthotics. This mirrors existing exemptions for physicians, allowing these professionals to provide items without entering government bidding contracts.
- Improved Access to Replacements: Medicare coverage for replacing prosthetic devices is extended to include custom-fitted orthotics (made to fit a specific patient) and custom-fabricated orthotics (built from scratch for an individual). This ensures beneficiaries can get replacements when needed, similar to how artificial limbs are handled.
- Implementation Timeline: The Secretary of Health and Human Services (HHS) must issue final rules to put these changes into effect within one year of the bill becoming law.
Significant Changes to Existing Law
- Amends Section 1834(h) of the Social Security Act to prohibit payments for drop-shipped orthotics and prosthetics, addressing gaps in prior rules that allowed such shipments without ensuring proper patient education.
- Modifies Section 1847(a) to broaden exemptions from competitive bidding beyond just physicians, promoting direct involvement by specialized therapists and fitting experts.
- Updates Section 1834(h)(1)(G) to explicitly cover replacements for custom orthotics, which were not as clearly protected before, enhancing continuity of care.
Potential Impacts
- On Citizens (Medicare Beneficiaries): Improves safety and access to personalized care, reducing risks from poorly fitted devices and ensuring training on use, which could lead to better health outcomes for those with limb loss or orthopedic issues.
- On Government Agencies: HHS will need to develop and enforce new regulations, potentially increasing short-term administrative workload but leading to long-term savings by curbing fraud and waste in Medicare spending on orthotics and prosthetics (estimated to be a multi-billion-dollar area).
- On Providers and Suppliers: Therapists, orthotists, and prosthetists gain more flexibility in supplying devices, while mail-order or drop-ship suppliers may face restrictions, possibly shifting market dynamics toward in-person care.
- International Relations: No direct impact, as this is a domestic Medicare policy focused on U.S. healthcare delivery.
Main Stakeholders Affected
- Medicare Beneficiaries: Primarily those with limb loss, amputations, or orthopedic conditions, who will benefit from safer, more accessible care.
- Healthcare Providers: Orthotists, prosthetists, physical therapists, and occupational therapists, who gain exemptions and roles in direct fitting and training.
- Suppliers and Manufacturers: Companies involved in orthotics and prosthetics, especially those using drop shipments, which may need to adapt business models.
- Government Entities: HHS and the Centers for Medicare & Medicaid Services (CMS), responsible for oversight, rulemaking, and payment administration.
- Taxpayers: Indirectly affected through potential reductions in Medicare waste and fraud, leading to more efficient use of public funds.
Notable Legal, Constitutional, or Political Implications
- Legal: Strengthens patient protections under Medicare by mandating practitioner involvement, which could reduce liability for improper device use but may invite challenges from suppliers affected by the drop-shipment ban. The one-year rulemaking deadline ensures timely implementation without undue delay.
- Constitutional: No apparent issues, as the bill operates within Congress's authority to regulate interstate commerce and federal spending programs like Medicare.
- Political: Bipartisan sponsorship (introduced by representatives from both parties) highlights focus on vulnerable populations and healthcare efficiency. It could set a precedent for prioritizing patient-centered care in federal programs, potentially influencing future reforms in medical device coverage amid ongoing debates on Medicare costs and fraud prevention.
This summary was generated by AI and may contain inaccuracies. Refer to the official source document for the authoritative text.
Sponsor
Rep. Thompson, Glenn [R-PA-15]
Cosponsors (31)
Rep. Thompson, Mike [D-CA-4], Rep. Bilirakis, Gus M. [R-FL-12], Rep. Dingell, Debbie [D-MI-6], Rep. Ruiz, Raul [D-CA-25], Rep. Davis, Donald G. [D-NC-1], Rep. Meuser, Daniel [R-PA-9], Rep. Lawler, Michael [R-NY-17], Rep. Crow, Jason [D-CO-6], Rep. Brownley, Julia [D-CA-26], Rep. Gottheimer, Josh [D-NJ-5], Rep. Davids, Sharice [D-KS-3], Del. Norton, Eleanor Holmes [D-DC-At Large], Rep. Perez, Marie Gluesenkamp [D-WA-3], Rep. Jayapal, Pramila [D-WA-7], Rep. Bost, Mike [R-IL-12], Rep. Craig, Angie [D-MN-2], Rep. Balderson, Troy [R-OH-12], Rep. Vindman, Eugene Simon [D-VA-7], Rep. McGovern, James P. [D-MA-2], Rep. Sewell, Terri A. [D-AL-7], Rep. Thanedar, Shri [D-MI-13], Rep. Cohen, Steve [D-TN-9], Rep. Harder, Josh [D-CA-9], Rep. Kelly, Mike [R-PA-16], Rep. Neguse, Joe [D-CO-2], Rep. Murphy, Gregory F. [R-NC-3], Rep. Fitzpatrick, Brian K. [R-PA-1], Rep. Sessions, Pete [R-TX-17], Rep. Bishop, Sanford D. [D-GA-2], Rep. Stansbury, Melanie A. [D-NM-1], Rep. Moran, Nathaniel [R-TX-1]
Recent Actions
- 2025-07-17: 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.
- 2025-07-17: 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.
- 2025-07-17: Introduced in House
- 2025-07-17: Introduced in House
Bill Versions
- Medicare Orthotics and Prosthetics Patient-Centered Care Act — issued 2025-07-17 — PDF (4 pages)