The Medicare O&P Patient-Centered Care Act:
Timely access to reasonable and necessary orthotic and prosthetic (“O&P”) care is critically important to ensure that Medicare beneficiaries with limb loss and limb difference in need of orthotic braces and prosthetic limbs maintain and improve their health and live as independently as possible. O&P clinical care is a combination of clinical services that culminate in the provision of an orthosis or prosthesis that satisfies the unique needs of each patient. Clinical care is necessary to ensure the fit and function of all limb prostheses and custom orthoses.
Appropriate O&P care can mean the difference between a functional, active lifestyle and a life of disability, dependency, and a shortened lifespan. The Medicare Orthotics and Prosthetics Patient-Centered Care Act would ensure beneficiary access to patient-centered clinical O&P care through the following improvements to the Medicare program. The legislation would ensure:
- Patient Protection from Fraud and Abuse: Prohibit the practice of “drop shipping” custom fitted and fabricated orthoses and all prostheses to Medicare beneficiaries. Under this provision, only off-the-shelf (OTS) orthoses would be allowed to be drop shipped to the patient’s home without any clinical intervention by a provider or supplier. This prohibition would prevent unscrupulous suppliers, who rely on “lead generators” that operate through a model based on late-night advertisements and telemedicine companies, from shipping custom fitted and fabricated orthoses and all prostheses to Medicare beneficiaries without providing necessary clinical care. (section 2(a))
- Access to O&P Care from Quality Providers: Ensure that patients have access to the full range of orthotic care from their primary O&P practitioner rather than requiring patients to visit multiple providers in the case where the treating orthotist or prosthetist does not have a competitive bidding contract. This provision helps ensure efficient and convenient patient care and would treat O&P practitioners similarly to physicians and other practitioners as defined by the Secretary. Since O&P practitioners would be reimbursed according to the adjusted Medicare fee schedule established through the competitive bidding process for OTS orthoses, this provision should not cost the Medicare program any more than it will otherwise spend on OTS orthoses. (section 2(b))
- Patient Access to Appropriate O&P Care as their Needs Evolve: Ensure that Medicare beneficiaries have access to custom-fitted and custom-fabricated orthoses when a replacement is necessary due to a change in their condition or clinical needs, an irreparable change in the condition of the orthosis, or excessive cost of repairs. Currently, Medicare restricts the replacement of orthoses during the “reasonable useful lifetime” of the orthosis. These restrictions currently force Medicare beneficiaries to wait for a period of time, often five years, before they are eligible for Medicare coverage of a replacement orthosis. Section 428 of the Benefit Improvement and Protection Act of 2000 provides for an exception to continuous use and useful lifetime restrictions for prosthetic devices if an ordering physician determines that replacement device is medically necessary for certain reasons. This provision would extend the exception to custom-fitted and custom-fabricated orthotic devices. (section 2(c))
If you have any questions, contact Joe McTernan, Director of Health Policy and Strategic Affairs at jmcternan@AOPAnet.org.
Tariff Relief for Orthotic & Prosthetic Devices & Manufacturing Components/Materials:
The American Orthotic and Prosthetic Association (AOPA) is actively communicating with policy makers and elected officials regarding the consequential impact of tariffs on medical devices dispensed to millions of Americans living with limb loss, limb difference, and orthopedic mobility-limiting conditions. We join our colleagues in the medical device industry in calling for the continuation of existing and future tariff relief in order to maintain access to clinically necessary and appropriate orthotic and prosthetic care.
Orthotic and prosthetic patients in every state depend on a reliable network of supply chain distributors, manufacturers and fabricators, and patient care providers. Tariffs will have an impact on each of these individual sectors. When considered collectively, the combined tariffs will cause exponential cost increases. This may reduce access to critically needed healthcare services and may cause unsustainable financial harm to patient care providers that receive reimbursement amounts previously determined by the Federal Government without any financial consideration for tariffs.
AOPA agrees with a model that incorporates zero for zero reciprocal tariffs on materials used to facilitate the fabrication and delivery of orthotic and prosthetic medical devices. This model, which has been suggested by representatives of the Advanced Medical Technology Association (AdvaMed), would use existing humanitarian-based tariff exemptions such as those represented in section 9021.39.000 of the Harmonized Tariff Schedule of the United States (HTSUS), the Florence Agreement and the associated Nairobi Protocol, to provide essential relief to healthcare providers, manufacturers, and product suppliers, including those that make up the orthotic and prosthetic profession.
AOPA supports efforts to ensure that the United States is treated equitably and fairly in relationships with its foreign trade partners and believes a policy of zero for zero reciprocal tariffs for products and materials associated with the provision of healthcare services, including orthoses and prostheses, allows for the continued provision of necessary and appropriate care without incurring unsurmountable financial burdens resulting from tariffs on medical devices, components, and raw materials.
If you have any questions, contact Joe McTernan, Director of Health Policy and Strategic Affairs at jmcternan@AOPAnet.org.
The Veterans Supporting Prosthetics Opportunities and Recreational Therapy (SPORT) Act (H.R. 1971):
The SPORT Act was introduced by Rep. Mariannette Miller-Meeks (R-IA) and it would recognize prosthetic limbs for sports and recreational use as medically necessary under the VA benefit.
Why It Matters:
Although the Veterans Health Administration is generally known as being more generous than Medicare and other payers with respect to coverage of a spare prostheses or other types of prosthetic limbs, veterans with limb loss and limb difference across the country continue to face significant barriers to equal participation in physical activities to remain fit and healthy.
What the Bill Does:
- Expands funding and access to therapeutic adaptive sports and recreation programs.
- Improves coordination between VA facilities and community-based providers,
- Supports research and data collection on the impact of physical activity on veteran health outcomes, and
- Enhances training for VA staff on the benefits of holistic rehabilitation strategies.
If you have any questions, contact Joe McTernan, Director of Health Policy and Strategic Affairs at jmcternan@AOPAnet.org.
The Mobility Means Freedom Tax Credit Act (H.R.2320):
The Mobility Means Freedom Tax Credit Act was introduced by Rep. Steve Cohen (D-TN), this important bill would provide a meaningful, 50% refundable tax credit to help individuals afford essential mobility-related devices—including prosthetic limbs and orthotic braces—reducing financial barriers and supporting independence and health for people with mobility disabilities.
Why It Matters:
- Improves Access to Medically Necessary Devices: Out-of-pocket costs for O&P care can be significant—even with insurance. H.R. 2320 would provide direct financial relief to individuals and families.
- Includes the O&P Community: AOPA and other stakeholders successfully advocated to ensure that prosthetic and orthotic devices are explicitly included in the final version of the bill—correcting a past exclusion.
- Promotes Health and Reduces Long-Term Costs: Access to mobility technology helps prevent complications like falls, obesity, pressure injuries, and diabetes—lowering overall healthcare expenditures over the long term.
- Supports Independence and Economic Participation: Mobility enables individuals with limb loss or limb difference to fully participate in work, community, and family life.
What the Bill Does:
- Creates a refundable 50% tax credit for the purchase of: Artificial limbs (prosthetics), Orthotic devices (leg, arm, back, and neck braces) , Powered or manual wheelchairs, or Enhancements or features that improve the function of these devices.
- Makes mobility more affordable for millions of Americans living with mobility disabilities
The Mobility Means Freedom Tax Credit Act will help make critical mobility devices more accessible and affordable for individuals who rely on them to live healthy, independent lives.
If you have any questions, contact Joe McTernan, Director of Health Policy and Strategic Affairs at jmcternan@AOPAnet.org.
Congressionally Directed Medical Research Programs:
In 2014, Congress established the Orthotics and Prosthetics Outcomes Research Program (OPORP) in the U.S. Department of Defense to support research and evaluate prosthetic limbs and orthotic braces meant to improve the health and well-being of servicemembers, Veterans, and other individuals with limb loss or limb impairment. For FY 2026 AOPA and the O&P Alliance are requesting $15 million to fund the Orthotics and Prosthetics Outcomes Research program, and define O&P research as also eligble for funding under the Peer-Reviewed Medical Research Program.
View the O&P Alliance summary here.
If you have any questions, contact Joe McTernan, Director of Health Policy and Strategic Affairs at jmcternan@AOPAnet.org.
Funding for the National Limb Loss Resource Center:
AOPA supports the Amputee Coalition’s drive to secure federal funding for the National Limb Loss Resource Center (NLLRC). The NLLRC provides and supports programs which include referral services, peer visit matching, virtual support groups, limb loss limb difference education days, youth programming, workforce development, and education/outreach across the nation. The NLLRC also works with the VA and DoD in service to our Nation’s Veterans and active-duty service members, their families, and caregivers.
The Presidential Budget eliminated funding for the National Limb Loss Resource Center for federal fiscal year 2026 (FY26), which will begin on October 1st. Take action now to help secure the proper funding for the NLLRC in FY26!
Protecting Medicaid:
As of October 2024, 72.1 million Americans, more than 20% of the U.S. population, are enrolled in Medicaid (1).
Access to Medicaid benefits has been shown to improve health outcomes, as well as economic outcomes for eligible Americans. Medicaid access is especially important for individuals that rely on prostheses and/or orthoses to perform activities of daily living and to participate in therapeutic recreational activities. Given that Medicaid programs are crucial to disabled and financially challenged children and adults, funding reductions to these programs will be devastating to this population. Additionally, Medicaid provides financial protection to patients and healthcare providers. Finally, “the Congressional Budget Office estimates that long-term fiscal effects (higher income and tax revenues) of Medicaid spending on children can offset half or more of the initial Medicaid spending.”(2).
For these reasons, it is of great importance to protect Medicaid and its recipients. Please take a few moments to automatically email your legislators to tell them you support protecting Medicaid funding. The more we make our voices heard, the more likely we are to create positive change.
If you have any questions, contact Joe McTernan, Director of Health Policy and Strategic Affairs at jmcternan@AOPAnet.org.
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Advocating for our members and promoting the value of the O&P profession to legislators and policymakers is an important priority for AOPA. To do this, we address legislative and regulatory issues that affect all aspects of the industry, as well as patients. We also strive to keep our members informed about Washington’s legislative and regulatory activities through AOPAvotes and our twice-weekly SmartBrief updates. To keep informed about state legislative and regulatory activities visit the AOPA C0-OP.