Washington – This week, Reps. Mike Thompson (D-CA-05) and Glenn “GT” Thompson (R-PA-05) introduced H.R. 2599, the Medicare Orthotics and Prosthetics Improvement Act of 2017. This legislation will provide much needed protections for Medicare beneficiaries and other patients receiving prosthetic and orthotic services.
“Medicare beneficiaries in need of prosthetic and orthotic services deserve to know they’re getting the very best care,” Mike Thompson said. Keeping fraudulent providers out of Medicare will ensure patients get the treatment they deserve, and has the added benefit of reducing costs.”
“As a former recreational therapist and licensed nursing home administrator, I understand the challenges that those who have suffered serious injuries are facing,” GTThompson said. “It is our duty to ensure these individuals are not being subjected to further hardships and financial burdens as a result of fraud in the O&P sector. The Medicare Orthotics and Prosthetics Improvement Act of 2017 will strengthen the quality of care while reducing costs within the Medicare program—I am proud to introduce this important bipartisan measure.”
The Benefits Improvement and Protection Act (BIPA), which was signed into law in 2000, mandated that a “practitioner” or “supplier” had to be certified in order to be paid for certain orthotic and prosthetic services under Medicare.
However, the Center for Medicare and Medicaid Services (CMS) has not enforced these provisions since their enactment. This has led to an uptick of fraudulent payment to unlicensed providers, leaving Medicare patients vulnerable to substandard, and in some cases nonexistent, care.
The Medicare Orthotics and Prosthetics Improvement Act of 2017 would:
- Require CMS to reimburse only those providers who have been accredited or licensed in orthotics and prosthetics;
- Link the eligibility for payment to the qualification of the providers and the complexity of the device to patient needs for the purpose of targeted care;
- Establish orthotists and prosthetists as Medicare providers, distinguishing them from suppliers of Durable Medical Equipment (DME);
- Clarify that notes taken by orthotists and prosthetists regarding a particular patient should be considered a legitimate component of the patient’s medical record.