Senators Mark R. Warner (D-VA), Steve Daines (R-MT), Tammy Duckworth (D-IL), John Cornyn (R-TX), and Bill Cassidy (R-LA) introduced the Medicare Orthotics and Prosthetics Patient-Centered Care Act (S. 4503) in the Senate. Companion legislation was introduced in the House of Representatives by Reps. Mike Thompson (D-CA), Glenn Thompson (R-PA), and G.K. Butterfield (D-NC).
“Under current law, the provision of highly specialized orthotic and prosthetic care is improperly regulated in the same way as durable medical equipment (DME), which does not reflect the service our seniors receive under the Medicare program,” said Warner. “This commonsense legislation redesigns the way Medicare delivers orthotic and prosthetic care to ensure seniors have safe access to the care they need without adding any additional cost to the Medicare program.”
The Medicare Orthotics and Prosthetics Patient-Centered Care Act would:
· Create separate statutory requirements for the provision of orthoses and prostheses to reflect the distinction between the clinical, service-oriented nature of orthotics and prosthetics care and the commodity-based nature of DME.
· Restore Congress’ intended meaning of the term “minimal self-adjustment,” to more clearly define off-the-shelf orthoses that subject to Centers for Medicare and Medicaid Services’ competitive bidding program.
· Ensure that patients have access to the full range of orthotic care from one orthotic/prosthetic practitioner rather than requiring patients to visit multiple providers in the case where the treating orthotist or prosthetist does not have a competitive bidding contract.
· Prohibit the practice of shipping custom orthoses and prostheses to Medicare beneficiaries without the involvement of a clinically trained specialist, known as drop shipping, and prohibit drop shipment of off-the-shelf orthoses.
In a report to Congress, prohibiting the practice of drop shipping would help reduce the likelihood of Medicare waste, fraud, and abuse of orthotics and prosthetic benefits by operators of late-night advertisements and telemedicine companies. Just last year, the Department of Justice revealed a $1.2 billion telemedicine scam targeting orthotic and prosthetic beneficiaries.
“Distinguishing orthotics and prosthetics from durable medical equipment is the most pressing issue in my profession,” said J. Douglas Call, CP, president of Virginia Prosthetics & Orthotics, Roanoke, in a statement from Warner’s office. “The provision of orthotic and prosthetic care includes a professional service component that is simply not the same as DME. The majority of orthoses and prostheses are custom fabricated or custom fit and require the expertise of a licensed and certified orthoptist or prosthetist whom must earn a master’s of science degree(s) and complete a clinical residency before becoming certified and/or licensed practitioners.
“Simply put, there is a great deal—sometimes years—of personalized patient care provided by orthotists and prosthetists, and lumping them into DME makes little sense,” Call said. “I also appreciate Sen. Warner’s efforts to reduce Medicare waste, fraud, and abuse in the orthotic and prosthetic benefit by banning drop-shipping of orthotics. This hurts our profession, but more importantly it hurts patients and must be stopped.”
“The provision of orthotics and prosthetics care requires clinical services provided by highly trained practitioners. Currently, it is unfairly regulated through a DME lens instead of the clinical care lens,” said Jeff Lutz, CPO, president of the American Orthotic and Prosthetic Association. “By differentiating the clinical care in which orthoses and limb prostheses are provided from the provision of durable medical equipment, this important legislation will ensure patients get the safe, quality care they deserve.”