Full U.S. House Approves Legislation, Including Text to Legitimatize the Orthotist’s/Prosthetist’s Notes as Part of the Medical Record in Medical Necessity Determination


This afternoon, the full House of Representatives acted by consent on suspension to adopt H.R. 3178, a bill to cut red tape and make some non-controversial changes to the Medicare program. Included in this bill was a single provision on O&P– the long-awaited provision to recognize the orthotist-prosthetist’s notes as part of the medical record in Medicare Medical Necessity Determinations. Here is the specific text as enacted by the House:

1 SEC. 103. ORTHOTIST’S AND PROSTHETIST’S CLINICAL NOTES AS PART OF THE PATIENT’S MEDICAL RECORD.

Section 1834(h) of the Social Security Act (42 U.S.C. 1395m(h)) is amended by adding at the end the following new paragraph:

”(5) DOCUMENTATION CREATED BY ORTHOTISTS AND PROSTHETISTS.- For purposes of determining the reasonableness and medical necessity of orthotics and prosthetics, documentation created by an orthotist or prosthetist shall be considered part of the individual’s medical record to support documentation created by eligible professionals described in section 1848(k)(3)(B).”

AOPA wants to recognize and thank Reps. Mike Bishop (R-MI and a Ways & Means member), Glenn Thompson (R-PA) who advanced the similar provision as part of the broader Medicare O&P Improvement Act, H.R. 2599, and Mike Thompson (D-CA and a Ways & Means Committee Member), and both House Ways & Means Committee Chairman Kevin Brady (R-TX) and Richard Neal (D-MA and the Ranking Minority Member of the Ways & Means Committee), for their strong support which resulted in this important action. Now it is on to the Senate, where S. 1191, the Grassley-Warner bill, supported by Senators Cassidy (R-LA) and Duckworth (D-IL) will hopefully move forward similarly to favorable action.

AOPA will keep you updated on any developments.