,i  #aaf? ,,congress  #a/ ,session  ,h4 
,r4 #ebfb  ,,9 ,,! ,,h\se ,,(           
,,repres5tatives  ,novemb] #bb1         
#bjai,mr4 ,?ompson ( ,cali=nia 7=       
himself1 ,mr4 ,?ompson ( ,p5nsylvania1  
,mr4 ,gu?rie1 & ,mr4 ,butt]field7       
introduc$ ! foll[+ bill2 :i* 0 ref]r$ to
 ! ,committee on ,en]gy & ,comm]ce1 & 9 
addition to ! ,committee on ,ways &     
,means1 = a p]iod to be subsequ5tly     
det]m9$ by ! ,speak]1 9 ea* case =      
consid]ation ( su* provisions z fall )9 
! jurisdiction ( ! committee conc]n$  ,a
 ,,bill  ,to am5d title ,,xviii ( !     
,social ,security ,act to protect       
b5efici>ies ) limb loss & o!r or?op$ic  
conditions by provid+ access to         
appropriate1 safe1 effective1           
pati5t-c5t]$ or?otic & pro/hetic c>e1 to
 r$uce fraud1 wa/e1 & abuse ) respect to
 or?otics & pro/hetics1 & = o!r         
purposes4  #a4 ,%ort title ,?is ,act may
 be cit$ z ! ,m$ic>e ,or?otics &        
,pro/hetics ,pati5t-,c5t]$ ,c>e ,act4   
#b4 ,increas+ protections = b5efici>ies 

receiv+ or?otic & pro/hetic c>e "u !    
,m$ic>e program  7a7 ,di/+ui%+ or?oti/s 
& pro/heti/s f suppli]s ( durable m$ical
 equipm5t & supplies ,section #ahcd ( ! 
,social ,security ,act 7#db ,u4,s4,c4   
#aciem7 is am5d$--  7#a7 9 subsection   
7j77#e71 by /rik+ subp>agraph 7,c7 &    
r$esignat+ ! subsequ5t subp>agraphs     
accord+ly2 &  7#b7 by add+ at ! end !   
foll[+ new subsection3  7x7 ,requirem5ts
 = or?oti/s & pro/heti/s  7#a7 ,issuance
 & r5ewal ( suppli] numb]  7,a7 ,paym5t 
7i7 ,9 g5]al ,no paym5t may be made "u  
?is "p to an or?otic or pro/hetic       
suppli] unless su* or?otic or pro/hetic 
suppli] obta9s 7& r5ews at su* int]vals 
z ! ,secret>y may require7 a suppli]    
numb]4  7ii7 ,cl>ification reg>d+       
provid]s "u "p ,a ,no?+ 9 clause 7i7    
%all prohibit a provid] o!rwise p]mitt$ 
to receive paym5t = or?otics &          
pro/hetics "u "p ,a f cont9u+ to receive
 paym5t "u su* "p )\t int]ruption4  7,b7
 ,/&>ds = possess+ a suppli] numb] ,an  
or?otic or pro/hetic suppli] may only   

obta9 a suppli] numb] if ! suppli] meets
 /&>ds prescrib$ by ! ,secret>y t       
include requirem5ts t ! or?otic or      
pro/hetic suppli] 7&1 :]e applicable1 ! 
or?oti/ or pro/heti/7--  7i7 lic5sure & 
accr$itation-- 7,i7 complies ) all      
applicable ,/ate & ,f$]al lic5sure &    
regulatory requirem5ts2 &  7,,ii7       
acquires accr$itation f ! ,am]ican ,bo>d
 = ,c]tification 9 ,or?otics1           
,pro/hetics & ,p$or?ics1 ,inc4 or !     
,bo>d ( ,c]tification_/,accr$itation1   
,int]national1 or o!r accr$itation      
entity t ! ,secret>y det]m9es has /&>ds 
t are equival5t to ! /&>ds ( su* ,bo>ds2
  7ii7 ma9ta9s a physical facility on an
 appropriate site2  7iii7 has pro( (    
appropriate liability insurance2 &  7iv7
 meets su* o!r requirem5ts z ! ,secret>y
 %all specify4  7,c7 ,prohibition aga9/ 
multiple suppli] numb]s ,! ,secret>y may
 n issue m ?an "o suppli] numb] to any  
or?otic or pro/hetic suppli] unless !   
,secret>y f9ds t ! issuance ( m ?an "o  
numb] is appropriate to id5tify o!r     

entities "u ! own]%ip or control ( !    
or?otic or pro/hetic suppli]4  7#b7     
,ord] = or?otics or pro/hetics  7,a7    
,in=mation provid$ by or?oti/s &        
pro/heti/s on detail$ writt5 ord]s =    
or?otics & pro/hetics ,an or?oti/ or    
pro/heti/ may di/ribute to physicians1  
physician assi/ants1 nurse practition]s1
 cl9ical nurse speciali/s1 or           
individuals entitl$ to b5efits "u ?is   
"p1 a detail$ writt5 ord] = or?otics or 
pro/hetics 7z def9$ 9 p>agraph 7#e77 =  
comm]cial purposes t conta9s ! foll[+   
in=mation3  7i7 ,! id5tification (--    
7,i7 ! or?otic or pro/hetic suppli]2 &  
7,,ii7 ! individual to :om ! or?otics or
 pro/hetics are furni%$4  7ii7 ,!       
id5tification ( ! treat+ physician1     
physician assi/ant1 nurse practition]1  
or cl9ical nurse speciali/4  7iii7 ,a   
description ( ! or?otics or pro/hetics  
ord]$4  7iv7 ,! date ( ! ord] describ$ 9
 ?is subp>agraph4  7,b7 ,in=mation on   
cod+ & descriptors ( compon5ts provid$  
,if an or?oti/ or pro/heti/ di/ributes a

 detail$ writt5 ord] = or?otics or      
pro/hetics describ$ 9 subp>agraph 7,a71 
! or?oti/ or pro/heti/ %all also li/ on 
! ord] ! summ>y descriptors ( ! items & 
s]vices be+ recomm5d$ prior to          
submission ( ! ord] to ! treat+         
physician = approval4  7,c7 ,signature  
by treat+ physician ,a detail$ writt5   
ord] = or?otics or pro/hetics describ$ 9
 subp>agraph 7,a7 %all be sign$ by !    
treat+ physician4  7#c7 ,limitation on  
pati5t liability ,except z provid$ 9    
p>agraph 7#d71 if an or?oti/ or         
pro/heti/-- 7,a7 furni%es an or?osis or 
pro/hesis to a b5efici>y = :i* no paym5t
 may be made "u ?is "p2 or  7,b7 subject
 to section #ahgi1 furni%es an or?osis  
or pro/hesis to a b5efici>y = :i* paym5t
 is d5i$ "u section #ahfb7;a77#a71  any 
exp5ses incurr$ = ! or?osis or pro/hesis
 furni%$ to an individual by ! or?oti/  
or pro/heti/ n on an assign$ basis %all 
be ! responsibility ( su* or?oti/ or    
pro/heti/4 ,! individual %all h no      
f9ancial responsibility = su* exp5ses & 

! or?oti/ or pro/heti/ %all refund on a 
timely basis to ! individual 7& %all be 
liable to ! individual =7 any am\nts    
collect$ f ! individual = su* items &   
s]vices4 ,! provisions ( subsection     
7a77#ah7 %all apply to refunds requir$  
"u ! previ\s s5t5ce 9 ! same mann] z su*
 provisions apply to refunds "u su*     
subsection4  7#d7 ,pati5t liability ,if 
an or?oti/ or pro/heti/ furni%es an     
or?osis or pro/hesis to a pati5t = :i*  
paym5t is d5i$ 9 advance "u subsection  
7a77#ae71 exp5ses incurr$ = su* or?osis 
or pro/hesis furni%$ to ! individual by 
! or?oti/ or pro/heti/ %all be !        
responsibility ( ! individual4  7#e7    
,def9itions ,9 ?is subsection3 7,a7     
,detail$ writt5 ord] = or?otics or      
pro/hetics  7i7 ,9 g5]al ,! t]m detail$ 
writt5 ord] = or?otics or pro/hetics    
means a =m or o!r docum5t prep>$ by an  
or?oti/ or pro/heti/ & sign$ by !       
physician 7z def9$ by section #ahfa7r77 
t conta9s in=mation requir$ by !        
,secret>y to %[ t an or?osis or         

pro/hesis is reasonable & necess>y = !  
treatm5t ( an illness or injury or to   
improve ! function+ ( a mal=m$ body     
memb]4  7ii7 ,cl>ification ,! detail$   
writt5 ord] = or?otics or pro/hetics    
%all n be consid]$ alone = purposes (   
det]m9+ ! reasonabl5ess1 m$ical         
necessity1 & functional level           
7applicable to pro/hetics7 ( or?otics & 
pro/hetics4  7,b7 ,or?otics & pro/hetics
 ,! t]m or?otics & pro/hetics has !     
mean+ giv5 t t]m 9 section              
#ahcd7;h77#d77;,c74  7,c7 ,or?oti/ or   
pro/heti/ ,! t]m or?oti/ or pro/heti/   
means an individual :o is specifically  
tra9$ & educat$ 9 ! provision (1 &      
pati5t c>e managem5t relat$ to1         
pro/hetics & cu/om-fabricat$ or         
cu/om-fit or?otics1 &--  7i7 9 ! case ( 
a ,/ate t provides = ! lic5s+ ( or?oti/s
 & pro/heti/s1 is lic5s$ by ! ,/ate 9   
:i* ! or?otics or pro/hetics 7 suppli$2 
or  7ii7 9 ! case ( a ,/ate t does n    
provide = ! lic5s+ ( or?oti/s &         
pro/heti/s1 is c]tifi$ by ! ,am]ican    

,bo>d = ,c]tification 9 ,or?otics1      
,pro/hetics & ,p$or?ics1 ,inc4 or by !  
,bo>d ( ,c]tification_/,accr$itation1   
,int]national1 or is c]tifi$ & approv$  
by an entity t ! ,secret>y det]m9es has 
c]tification & approval /&>ds t are     
ess5tially equival5t to ! c]tification &
 approval /&>ds ( su* ,bo>ds4  4  7b7   
,prohibit+ paym5t = c]ta9 or?otics &    
pro/hetics ,section #ahcd7;h77#a7 ( !   
,social ,security ,act 7#db ,u4,s4,c4   
#aciem7h77#a77 is am5d$ by add+ at ! end
 ! foll[+ new subp>agraph3  7,i7        
,special paym5t rules = or?otics or     
pro/hetics  7i7 ,9 g5]al ,no paym5t %all
 be made "u ?is subsection =-- 7,i7 a   
pro/hesis 7exclud+ pro/hetic supplies7 t
 is deliv]$ by drop %ipm5t2  7,,ii7 a   
cu/om-fabricat$ or cu/om-fitt$ or?osis  
7exclud+ or?otic supplies7 describ$ 9   
subp>agraph 7,f77ii7 t is deliv]$ by    
drop %ipm5t2 &  7,,iii7 an or?otic item 
t is n o!rwise competitively bid t is   
deliv]$ by drop %ipm5t4  7ii7 ,drop     
%ipm5t def9$ ,9 ?is subp>agraph1 ! t]m  

drop %ipm5t means ! %ipp+ ( an or?osis  
or pro/hesis to a b5efici>y )\t receiv+ 
f a tra9$1 educat$1 & c]tifi$ or lic5s$ 
heal? c>e practition]1 or?oti/1 or      
pro/heti/ direct pati5t c>e ) respect to
 assess+1 adju/+1 & tra9+ 9 ! c>e & use 
( ! or?osis or pro/hesis4  4  7c7       
,/&>diz+ ! def9itions ( or?otics &      
pro/hetics ,section #ahcd7;h77#d7 ( !   
,social ,security ,act 7#db ,u4,s4,c4   
#aciem7h77#d77 is am5d$-- 7#a7 9        
subp>agraph 7,b71 by /rik+ at ! end &2  
7#b7 9 subp>agraph 7,c7-- 7,a7 by /rik+ 
! t]m or?otics & pro/hetics has ! mean+ 
giv5 su* t]m & ins]t+ ! t]ms or?otics & 
pro/hetics & or?oses & pro/heses h !    
mean+ giv5 su* t]ms2 &  7,b7 by /rik+ ! 
p]iod at ! end & ins]t+ 2 &2 &  7#c7 by 
ins]t+ aft] subp>agraph 7,c71 z am5d$ by
 p>agraph 7#b71 ! foll[+ new            
subp>agraph3  7,d7 ! t]ms pro/hetics &  
pro/heses ref] to a device 7includ+ !   
cl9ical s]vices associat$ ) su* device7 
t replaces all or "p ( a limb4  4  7d7  
,limitation ( competitive acquisition = 

(f-!-,%elf or?otics ,section #ahdg7;a7 (
 ! ,social ,security ,act 7#db ,u4,s4,c4
 #aciew-#c7;a77 is am5d$-- 7#a7 9       
p>agraph 7#b77;,c71 by ins]t+ by !      
pati5t 7& n by ano!r p]son7 aft] m9imal 
self-adju/m5t2 &  7#b7 9 p>agraph       
7#g77;,a77i7-- 7,a7 by ins]t+ 1 or?oti/ 
or pro/heti/ 7z def9$ 9 section         
#ahcd7x77#e77;,c771 aft] by a physician2
  7,b7 by ins]t+ 1 or?oti/'s or         
pros!ti/'s1 aft] to ! physician's2 &    
7,c7 by ins]t+ 1 or?oti/'s or           
pros!ti/'s1 aft] ( ! physician's4  7e7  
,regulations ,n lat] ?an #a ye> aft] !  
date ( ! enactm5t ( ?is ,act1 !         
,secret>y ( ,heal? & ,human ,s]vices    
%all promulgate f9al regulations to     
implem5t ! provisions (1 & am5dm5ts made
 by1 ?is ,act4