WASHINGTON – Today, U.S. Sens. Mark R. Warner (D-VA) and Steve Daines (R-MT), members of the Senate Finance Committee, reintroduced legislation to improve orthotics and prosthetics care for seniors on Medicare. The Medicare Orthotics and Prosthetics Patient-Centered Care Act would strengthen Medicare patients’ access to quality orthotics and prosthetics by reducing fraud, expanding access to replacement devices, and removing burdensome regulations that disproportionally hurt orthotists and prosthetists.

“Seniors need quality orthotics and prosthetics care, but hurdles in the industry are making care less accessible while also burdening Medicare and providers,” said Sen. Warner. “This bipartisan legislation would alleviate issues across the orthotics and prosthetics industry so seniors don’t receive unusable devices and also cut unnecessary red tape for orthotists and prosthetists.” 

“Many Montana seniors rely on orthopedic braces or prosthetics but unfortunately the risk of abuse within the Medicare system can stand in the way of quality care,” said Sen. 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.”

Specifically, the Medicare Orthotics and Prosthetics Patient-Centered Care Act would:

• Prevent fraud by prohibiting “drop shipping” of devices that patients should come in and be fitted for.
• Exempt orthotists and prosthetists from more restrictive policies that apply to them but not other health care providers in order to sell non-fitted devices.
• Ensure Medicare beneficiaries have timely access to a replacement device if a provider determines it’s necessary due to a change in the condition of the patient, the condition of the device, or if the cost of repair would be excessive.

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 the “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 rampant 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, potentially saving Medicare billions of dollars.

Additionally, Medicare regulations do not cover replacements for orthotics or prosthetics within the “reasonable use lifetime,” even if they 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.

In the House of Representatives, Reps. Glenn Thompson (R-PA-15), Mike Thompson (D-CA-04), Brett Guthrie (R-KY-02), and Angie Craig (D-MN-02) have introduced companion legislation. 

“The American Orthotic and Prosthetic Association (AOPA) applauds Senators Mark Warner and Steve Daines for their efforts in introducing the bipartisan Medicare O&P Patient-Centered Care Act in the Senate. For years, AOPA and its over 1,500 members representing both the facilities that treat individuals living with limb loss and limb difference and the manufacturers of orthotic and prosthetic (O&P) devices, have been advocating for Medicare to protect patients’ access to quality O&P clinical care. This legislation would do this while also addressing fraudulent practices that are costly to the Medicare system,” said Eve Lee, MBA CAE, AOPA Executive Director. “If passed, it will impact the lives of millions of Americans living with limb loss and limb difference. We appreciate Senator Warner and Daines’ continued commitment to the O&P profession and the patients its serves.”

“Senator Warner has been a longtime supporter of the O&P profession. The Virginia Orthotic and Prosthetic Association (VOPA) thanks him for continuing this support by once again introducing the Medicare Orthotics and Prosthetics Patient-Centered Care Act,” said Mike Malagari, CO, FAAOP, VOPA President. “Since 2007, VOPA has been advocating for the needs of the O&P facilities in Virginia and their patients. This legislation will go a long way in helping the facilities provide quality patient care to their patients. VOPA looks forward to working with Senator Warner to get this important legislation passed.”

“As Immediate Past President of Northwest Chapter of the American Academy of Orthotists and Prosthetists (NWAAOP), representing over 400 orthotists and prosthetists spanning five states including Washington, Oregon, and Montana, we are incredibly grateful to Senator Daines’ for his continued support of the orthotic and prosthetic profession and the patients we serve,” said Ben Clark, CPO, NWAAOP Immediate Past President. “Senator Daines has been a primary co-sponsor of this legislation for the last two Congresses, dating back to 2021, and continues to advocate on our behalf. This legislation is key to preventing fraud and abuse and to make certain that patients are receiving the best quality interventions. NWAAOP looks forward to continuing our work with Senator Daines.”

Additionally, this bill has been endorsed by numerous organizations including the American Orthotic and Prosthetic Association; American Academy of Orthotists and Prosthetists; American Board for Certification in Orthotics, Prosthetics, and Pedorthics Board of Certification/Accreditation; National Association for the Advancement of Orthotics & Prosthetics; American Podiatric Medical Association; American Occupational Therapy Association; American Physical Therapy Association; American Society of Hand Therapists; Access Ready; ACCSES; Alexander Graham Bell Association for the Deaf and Hard of Hearing; American Association on Health and Disability; American Cochlear Implant Alliance; American Congress of Rehabilitation Medicine; American Music Therapy Association; American Occupational Therapy Association; American Physical Therapy Association; American Therapeutic Recreation Association; Amputee Coalition; Association of Rehabilitation Nurses; Autistic Women & Nonbinary Network; Buoniconti Fund to Cure Paralysis; Center for Medicare Advocacy; Chris and Dana Reeve Foundation; Council of State Administrators of Vocational Rehabilitation; Institute for Matching Person & Technology; Lakeshore Foundation; Medical Device Manufacturers Association; Miami Project to Cure Paralysis; Muscular Dystrophy Association; National Association for the Advancement of Orthotics and Prosthetics; National Association of Councils on Developmental Disabilities; National Association of Rehabilitation Providers and Agencies; National Association of Rehabilitation Research and Training Centers; National Disability Rights Network; National Registry of Rehabilitation Technology Suppliers; Paralyzed Veterans of America; RESNA; Simon Foundation for Continence; Spina Bifida Association; The Viscardi Center; United Cerebral Palsy; United Spinal Association; and VisionServe Alliance.

Text of the bill is available here. 

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