U.S. Senator Steve Daines today introduced bipartisan legislation to improve access to orthotics and prosthetics for seniors in Medicare. The “Medicare Orthotics and Prosthetics Patient-Centered Care Act” would reduce fraud, expand access, and address other barriers to quality care, while saving critical dollars in the Medicare program.
“Many Montana seniors rely on orthopedic braces or prosthetics but unfortunately the potential for abuse within Medicare can stand in the way of quality care,” said Daines. “I’m glad to introduce this bipartisan bill to expand access to needed orthotics and prosthetics for our seniors and reduce waste and fraud in order to better serve Montana patients.”
Read the full text of the bill HERE.
Specifically, the Medicare Orthotics and Prosthetics Patient-Centered Care Actwould:
- Prevent fraud by prohibiting “drop shipping” of devices for which patients should see their provider in order to be fitted.
- Exempt orthotists and prosthetists from more restrictive policies that apply to them but not other health care providers in order to provide non-custom devices.
- Ensure Medicare beneficiaries have timely access to a replacement device when a provider determines replacement is necessary based on certain conditions.
The majority of orthotics and prosthetics are custom-fabricated or custom-fitted and require the expertise of a certified or licensed orthotist or prosthetist. However, Medicare currently reimburses “drop shipment” (or direct-to-consumer shipping) of custom orthoses and prostheses directly to patients without the input of a medical professional, which leads to waste and fraud, as the delivered devices may not actually meet a patient’s needs. The “Medicare Orthotics and Prosthetics Patient-Centered Care Act”would prohibit that practice, ensuring beneficiaries have the right devices and providing savings to Medicare.
Additionally, Medicare does not cover replacements for orthotics or prosthetics within the “reasonable use lifetime,” even if devices are irreparably damaged or there has been a change in the condition of the patient. The bill would close that loophole, allowing coverage for replacements if the patient meets certain conditions. Finally, the bill implements a zero-cost regulatory fix that would allow certified orthotists and prosthetists to be exempted from sending patients to a provider with a competitive bidding license, removing an unnecessary barrier to care for patients and making sure orthotists and prosthetists aren’t subject to unnecessarily stringent requirements.