Closing Loopholes, Opening Doors: The Medicare Orthotics and Prosthetics Patient-Centered Care Act

In a critical juncture for healthcare policy, the American Orthotic and Prosthetic Association (AOPA) is poised to make waves in Washington, D.C. during the April 2024 Policy Forum . Their mission: to garner support in the House and Senate for the passage of the Medicare Orthotics and Prosthetics Patient-Centered Care Act. With bipartisan backing, this legislation was introduced in the House in June of 2023 and now has 35 cosponsors.  The significance of this act for orthotists, prosthetists, and their patients cannot be overstated – it represents a monumental shift towards patient-centered care and a statutory and regulatory separation of O&P from the umbrella of DME, allowing for more appropriate regulation in the future. 

This legislation, introduced to the Senate in March 2024 by Senators Mark Warner (D-VA) and Steve Daines (R-MT), promises wins for both patients and the industry – it extends beyond accessibility concerns. Currently, Medicare reimburses the direct-to-consumer shipping of custom orthoses and prostheses, leading to rampant waste and fraud for devices that are not truly OTS. The Medicare Orthotics and Prosthetics Patient-Centered Care Act seeks to put an end to this practice, potentially saving Medicare billions of dollars while ensuring patients receive devices tailored to their needs.

The act also addresses the burden of competitive bidding practices. Patients, especially affected in rural areas, would no longer need to be sent to a second provider with a competitive bidding license if the primary orthotist or prosthetist had a not won a competitive license. This exemption would reduce the burden of access placed on patients and alleviate unnecessarily stringent requirements for providers. Additionally, Medicare beneficiaries will be covered for replacement devices reflecting “reasonable use” in the lifetime of the device. Patients will be able to access replacement custom-fitted and custom-fabricated devices if they meet certain conditions. 

“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.” 

One of the crucial differentiators introduced by the act is its recognition of the clinical nature of O&P care , distinct from durable medical equipment (DME). This crucial distinction acknowledges the specialized care required by patients and ensures appropriate regulation. 

As AOPA members convene in Washington, D.C. this month, they are not merely advocating for a piece of legislation; they are championing a paradigm shift in healthcare. The Medicare Orthotics and Prosthetics Patient-Centered Care Act represents a beacon of hope for Medicare beneficiaries in need of orthotic and prosthetic care, and hope for the providers of O&P devices. 

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