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Enhancing Medicare Beneficiaries' Access to Orthotics and Prosthetics: A Legislative Update

In recent years, Medicare beneficiaries requiring orthotic and prosthetic (O&P) care have faced significant challenges, including limited access to necessary devices and susceptibility to fraudulent practices. To address these issues, bipartisan efforts have been made to introduce legislation aimed at improving the quality and accessibility of O&P services for Medicare recipients.

The Medicare Orthotics and Prosthetics Patient-Centered Care Act

On June 23, 2023, Representatives Glenn "GT" Thompson (R-PA), Mike Thompson (D-CA), Brett Guthrie (R-KY), and Angie Craig (D-MN) introduced H.R. 4315, known as the Medicare Orthotics and Prosthetics Patient-Centered Care Act. This bill seeks to amend Title XVIII of the Social Security Act to ensure that Medicare beneficiaries have access to appropriate, safe, and effective O&P care. 

Key Provisions of the Act

The proposed legislation includes several critical measures designed to enhance patient care and reduce fraudulent activities:

  • Prohibition of Drop Shipping: The act aims to eliminate the practice of direct-to-patient shipping for custom-fitted and fabricated orthoses and prostheses without proper clinical intervention. This measure is intended to prevent the distribution of ill-fitting or inappropriate devices, thereby reducing waste and potential harm to patients.

  • Exemption from Competitive Bidding: The bill proposes exemptions for qualified practitioners, including orthotists and prosthetists, from certain competitive bidding requirements. This change would allow these professionals to provide necessary O&P devices without the constraints of competitive bidding contracts, facilitating timely and personalized patient care.

  • Facilitating Access to Replacement Devices: The legislation seeks to ensure that Medicare beneficiaries can obtain replacement orthotic or prosthetic devices when medically necessary due to changes in the patient's condition or the device's integrity. This provision addresses current limitations that often delay or deny access to essential replacement devices. 

Bipartisan Support and Advocacy

The introduction of H.R. 4315 has garnered bipartisan support, reflecting a shared commitment to improving healthcare outcomes for individuals requiring O&P services. In the Senate, a companion bill, S. 3977, was introduced by Senators Mark Warner (D-VA) and Steve Daines (R-MT), further emphasizing the collaborative effort to advance this critical legislation. 

Advocacy organizations, such as the American Orthotic and Prosthetic Association (AOPA), have expressed strong support for the act, highlighting its potential to safeguard patient access to high-quality care while combating fraudulent practices within the Medicare system. 

Implications for Medicare Beneficiaries

The bill was referred to the Subcommittee on Health in December of 2024. If enacted, the Medicare Orthotics and Prosthetics Patient-Centered Care Act would represent a significant step forward in ensuring that Medicare beneficiaries receive personalized and clinically appropriate O&P care. By addressing existing gaps in the system, the legislation aims to enhance the quality of life for individuals relying on these essential medical devices.

As the legislative process unfolds, continued bipartisan collaboration and advocacy will be crucial in advancing the goals of this act, ultimately leading to improved healthcare services and outcomes for Medicare beneficiaries nationwide.

NeoTrek’s Role in Advancing #FootEquity

As legislation works to improve access to orthotics and prosthetics, NeoTrek Footwear is proud to support individuals with unique foot anatomies by providing high-quality, inclusive solutions. Our Truer-Fit™ Socks, available online now, and custom-fit sandals and running shoes, which will launch this spring, embody our commitment to #footequity—ensuring everyone has access to footwear that fits their needs. Visit our website and sign up to be among the first to hear about the debut of our custom-fit running shoes and sandals.

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