Medicare Orthotics and Prosthetics Patient-Centered Care Act

Legislation and regulation that may impact the practice and/or the profession of orthotics and prosthetics; Issues pertaining to Medicare competitive bidding including an exemption for orthotists and prosthetists; Medicare regulations in regards to the reasonable useful lifetime of orthoses; Medicare fraud and abuse especially the elimination of drop shipping of OTS orthoses, and limiting the elimination/lowering of Medicaid access, to remove select HCPCS codes from the next round of competitive bidding. Specific bills include the Medicare Orthotics and Prosthetics Patient-Centered Care Act (H.R 4475, S.2329).

Client expense: $30,000 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, SENATE

Medicare Orthotics and Prosthetics Patient-Centered Care Act(H.R 4475, S.2329). Legislation and regulation that may impact the practice and/or the profession of orthotics and prosthetics. These issues include health insurance coverage issues, managed care, Medicare reform, fraud and abuse, reasonable useful lifetime (RUL) restrictions, and FDA issues (no specific bills). Having TRICARE provide coverage for cranial remolding orthoses.

Client expense: $30,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Issues surrounding Medicare reimbursement and coverage denials Issues surrounding 2025 conversion factor and Medicare reimbursement reform (H.R. 3514/S.1816) Improving Seniors' Timely Access to Care Act (H.R. 1) One Big Beautiful Bill Act [P.L. No. 119-21] (H.R.4204) Medicare Patient Choice Act (H.R.4475/S.2329) Medicare Orthotics and Prosthetics Patient-Centered Care Act

Client expense: Not reported · Firm income: $20,000

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H.R.879 Medicare Patient Access and Practice Stabilization Act - support passage No bill number - Support an annual inflationary update or an increase for 2025 and 2026 to the Medicare Physician Fee Schedule No bill number - Support introduction and passage of the Provider Reimbursement Stability Act No bill number - Support a resumption and extension of telehealth waivers under Medicare after the January 31, 2026 expiration. H.R.2013 Medicare Home Health Accessibility Act - support passage and introduction of similar bill in Senate H.R.1614, therapy telehealth act - support passage S.1261/H.R.4206 CONNECT for Health Act - advocate for provision to establish OTs as permanent Medicare telehealth providers No bill number - Asking for potential carve out of schools from Medicaid referral requirement S.2847/H.R.4037 Occupational Therapy Mental Health Parity Act - support passage H.R. 926 - Support inclusion of language similar to H.R.4037/S.2847, the Occupational Therapy Mental Health Parity Act in report language H.R.4204 Medicare Patient Choice Act - support passage S.2329/H.R.4475 Medicare Orthotics and Prosthetics Patient-Centered Care Act - support passage S.2830 WELL Seniors Act - support passage S.2709/H.R.5081 Telehealth Modernization Act - support passage H.R.4559 Prompt and Fair Pay Act - support passage H.R.1171/S.2612 Stopping Addiction and Falls for the Elderly (SAFE) Act - support passage H.R. 8386 Removing Excessive Cuts to Outpatient and Vital Essential Rehabilitation (RECOVER) Act - support passage No bill number - Support legislation to make occupational therapy, physical therapy and speech language pathology a mandatory Medicaid benefit.

Client expense: $189,000 · Firm income: Not reported

Medicare Orthotics and Prosthetics Patient-Centered Care Act(H.R 4475, S.2329). Legislation and regulation that may impact the practice and/or the profession of orthotics and prosthetics. These issues include health insurance coverage issues, managed care, Medicare reform, fraud and abuse, reasonable useful lifetime (RUL) restrictions, and FDA issues (no specific bills).

Client expense: $30,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Legislation and regulation that may impact the practice and/or the profession of orthotics and prosthetics; Issues pertaining to Medicare competitive bidding including an exemption for orthotists and prosthetists; Medicare regulations in regards to the reasonable useful lifetime of orthoses; Medicare fraud and abuse especially the elimination of drop shipping of OTS orthoses, and limiting the elimination/lowering of Medicaid access, to remove select HCPCS codes from the next round of competitive bidding. Specific bills include the Medicare Orthotics and Prosthetics Patient-Centered Care Act (H.R 4475, S.2329).

Client expense: $30,000 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, SENATE

Issues surrounding Medicare reimbursement and coverage denials Issues surrounding 2025 conversion factor and Medicare reimbursement reform (H.R. 3514/S.1816) Improving Seniors' Timely Access to Care Act (H.R. 1) One Big Beautiful Bill Act [P.L. No. 119-21] (H.R.4204) Medicare Patient Choice Act (H.R.4475/S.2329) Medicare Orthotics and Prosthetics Patient-Centered Care Act

Client expense: Not reported · Firm income: $10,000

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H.R.879 Medicare Patient Access and Practice Stabilization Act - support passage No bill number - Support an annual inflationary update or an increase for 2025 and 2026 to the Medicare Physician Fee Schedule No bill number - Support introduction and passage of the Provider Reimbursement Stability Act No bill number - Support a resumption and extension of telehealth waivers under Medicare after the January 31, 2026 expiration. H.R.2013 Medicare Home Health Accessibility Act - support passage and introduction of similar bill in Senate H.R.1614, therapy telehealth act - support passage S.1261/H.R.4206 CONNECT for Health Act - advocate for provision to establish OTs as permanent Medicare telehealth providers No bill number - Asking for potential carve out of schools from Medicaid referral requirement S.2847/H.R.4037 Occupational Therapy Mental Health Parity Act - support passage H.R.4204 Medicare Patient Choice Act - support passage S.2329/H.R.4475 Medicare Orthotics and Prosthetics Patient-Centered Care Act - support passage S.2830 WELL Seniors Act - support passage S.2709/H.R.5081 Telehealth Modernization Act - support passage H.R.4559 Prompt and Fair Pay Act - support passage H.R.1171/S.2612 Stopping Addiction and Falls for the Elderly (SAFE) Act - support passage No bill number - Support legislation to repeal the Medicare Multiple Procedure Payment Reduction applied to therapy services. No bill number - Support legislation to make occupational therapy, physical therapy and speech language pathology a mandatory Medicaid benefit.

Client expense: $189,000 · Firm income: Not reported

United Spinal, as a member of the Health and Long-Term Services and Supports Task force of the Consortium for Constituents with Disabilities (CCD), the Disability and Aging Collaborative (DAC), and allied organizations wrote to the Administrator of the Centers for Medicare and Medicaid Services to provide feedback on implementation of the new community engagement requirements enacted by the budget reconciliation act of 2025 (H.R. 1). The comments read in part, Congress intended to exempt people with disabilities and their caregivers from the community engagement requirements. With that in mind, we urge the Administration to use guidance and rulemaking to provide maximum protection for people with disabilities, older adults, and caregivers from coverage loss or disruption. The letter may be reviewed at: https://www.c-c-d.org/fichiers/Letter-from-Aging-and-Disability-Organizations-on-Medicaid-Community-Engagement-Requirements.pdf United Spinal supported and urged members of Congress to sign on to a letter to Dr. Mehmet Oz, Administrator, Centers for Medicare & Medicaid Services with concerns about expanding the agencys Competive Bidding Program. The letter read in part, As Members of Congress committed to advancing President Trumps America First agenda, we write to express serious concern that the Centers for Medicare and Medicaid Services proposed rule (CMS-1828-P) to expand and redesign the Durable Medical Equipment, Prosthetics, Orthotics, and Supplies Competitive Bidding Program may conflict with thePresidents directives on deregulation, trade, and domestic industrial strength. We respectfully urge CMS to pause and re-evaluate these provisions to ensure that they fully align with the Administrations goal of rebuilding American manufacturing, protecting Main Street businesses, and fostering innovation. United Spinal supported and advocated for members of Congress to sign onto a letter submitted țo the Administrator of the Centers for Medicare and Medicaid Services and the Director of the Office of Management and Budget. The letter read in part, We write to express our concerns regarding the Centers for Medicare & Medicaid Services (CMS) proposed Calendar Year (CY) Home Health proposed rules inclusion of ostomy, urological, and tracheostomy supplies in the Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program. We respectfully request that the proposal for inclusion of these products be withdrawn as we believe it would conflict with the Administrations goals to strengthen American manufacturing, secure our medical supply chains from foreign adversaries, and protect the health and well-being of our nations most vulnerable citizens. United Spinal, along with numerous other disability organizations and as members of the Independence Through Enhancement of Medicare and Medicaid (ITEM) Coalition, wrote to the bipartisan leadership of the House Ways and Means and Energy and Commerce Committees as well as the Senate Finance Committee to encourage the leadership of the Senate and House committees of jurisdiction over the Medicare program to continue working with the Centers for Medicare and Medicaid Services (CMS) to enable Medicare beneficiaries living with disabilities and chronic obesity to access anti-obesity medications (AOMs) through the Medicare Part D program. The ITEM Coalition firmly believes that Medicare beneficiaries living with obesity, especially individuals with mobility impairments, should have equal access to the full continuum of obesity treatment options available to those living with chronic diseases such as diabetes and cardiovascular conditions, conditions where AOMs are already covered. The House letter may be reviewed at: https://itemcoalition.org/wp-content/uploads/2025/11/item-letter-to-congressional-committee-leadership-on-anti-obesity-medications-final.pdf United Spinal, along with other members of the Independence Through Enhancement of Medicare and Medicaid (ITEM) Coalition (https://itemcoalition.org/), supported a Coalitions press statement that expressed deep disappointment with a final rule that exposes Medicare patients to the lowest bidder for ostomy and urological supplies, as well as certain orthotic braces, under the Medicare program. To make matters worse, CMS accelerated the timeline and some of the changes go into effect as early as next year. The full statement may be reviewed at: https://itemcoalition.org/wp-content/uploads/2025/12/item-coalition-competitive-bidding-program-expansion-press-statement-final.pdf United Spinal, as a member of the Independence Through Enhancement of Medicare and Medicaid (ITEM) Coalition, wrote to express our strong support for S. 2329, the Medicare Orthotics and Prosthetics (O&P) Patient-Centered Care Act, and thank you for sponsoring this important bill. As you know, this bipartisan and bicameral legislation would help Medicare beneficiaries who use orthoses and prostheses to be as functional and independent-as possible while limiting waste, fraud, and abuse in the Medicare orthotic and prosthetic benefit. We applaud your leadership in sponsoring this bill and hope to work with you and your colleagues in the relevant committees of jurisdiction and leadership to enact this bill into law as soon as practicable. Letter to Senate Sponsors: ITEM Coalition Letter of Support for S. 2329, the Medicare Orthotics and Prosthetics (O&P) Patient-Centered Care Act. United Spinal, as a member of the Independence Through Enhancement of Medicare and Medicaid (ITEM) Coalition, wrote to the House sponsors of H.R. 4475, the Medicare Orthotics and Prosthetics (O&P) Patient-Centered Care Act, to express our strong support and thank you for sponsoring this important bill. As you know, this bipartisan and bicameral legislation would help Medicare beneficiaries who use orthoses and prostheses to be as functional and independent as possible while limiting waste, fraud, and abuse in the Medicare orthotic and prosthetic benefit. We applaud your leadership in sponsoring this bill and hope to work with you and your colleagues in the relevant committees of jurisdiction and leadership to enact this bill into law as soon as practicable. Letter to House Sponsors: ITEM Coalition Letter of Support for H.R. 4475, the Medicare Orthotics and Prosthetics (O&P) Patient-Centered Care Act. United Spinal, as a member of the Independence Through Enhancement of Medicare and Medicaid (ITEM) Coalition strongly supported the expansion of Medicare coverage of sterile intermittent catheter kits for individuals with a spinal cord injury (SCI) regardless of the level of injury and submitted comments to the Durable Medical Equipment Medicare Administrative Contractors that read in part, While we support the proposed changes to the Local Coverage Determination (LCD, specifically, DL33803), we respectfully urge the Durable Medical Equipment Medicare Administrative Contractors (DME MACs) to go further in the final LCD or in future LCDs to consider evidence demonstrating that coverage should be expanded to all individuals with neurogenic bladder regardless of etiology, including congenital conditions. United Spinal provided comments to the DME MACs (Durable Medical Equipment Medicare Administrative Contractors) who had proposed Local Coverage Determination (LCD) for urological supplies. The comments read in part, United Spinal has long sought the physical and mental relief your proposed LCD will provide to those living with a spinal cord injury (SCI) by not requiring an individual to acquire two urinary tract infections (UTIs) within a 12-month period. Therefore, we are most pleased to comment on the proposal and to suggest how it could be expanded to further lower Americans health risks and further lower Americas healthcare costs. United Spinals policy fellow verbally commented to the DME MACs (Durable Medical Equipment Medicare Administrative Contractors) who had proposed Local Coverage Determination (LCD) for urological supplies. The comments, in part read: United Spinal has long objected to the truly barbaric requirement that if you have a spinal cord injury, an SCI, you must have two urinary tract infections within twelve months before closed system Intermittent catheters will be covered. So, on behalf of those with SCIs across America, thank you for your proposed Local Coverage Determination (LCD). We do ask please that in the final LCD you clarify that having a SCI equates to immunosuppression. That will save America and countless Americans a lot of time and money. Thank you also for considering and acting favorably on the clinical evidence about the immunosuppression of those of us with a SCI. But most respectfully, there is also more you must do. We urge you to please go further in the final LCD to consider clinical evidence demonstrating that coverage should be expanded to all individuals with neurogenic bladder regardless of cause, including congenital conditions.

Legislation and regulation that may impact the practice and/or the profession of orthotics and prosthetics; Issues pertaining to Medicare competitive bidding including an exemption for orthotists and prosthetists; Medicare regulations in regards to the reasonable useful lifetime of orthoses; Medicare fraud and abuse especially the elimination of drop shipping of OTS orthoses, and limiting the elimination/lowering of Medicaid access, Seeking exemption for tariffs on medical devices including orthotics and prosthetics. Specific bills include the Medicare Orthotics and Prosthetics Patient-Centered Care Act (H.R 4475, S.2329).

Client expense: $30,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Medicare Orthotics and Prosthetics Patient-Centered Care Act(H.R 4475, S.2329). Legislation and regulation that may impact the practice and/or the profession of orthotics and prosthetics. These issues include health insurance coverage issues, managed care, Medicare reform, fraud and abuse, reasonable useful lifetime (RUL) restrictions, and FDA issues (no specific bills).

Client expense: $30,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H.R.879 Medicare Patient Access and Practice Stabilization Act - support passage No bill number - Support an annual inflationary update or an increase for 2025 and 2026 to the Medicare Physician Fee Schedule No bill number - Support introduction and passage of the Provider Reimbursement Stability Act No bill number - Support a resumption and extension of telehealth waivers under Medicare after the September 30, 2025 expiration. H.R.1171 Stopping Addiction and Falls for the Elderly Act (SAFE Act) - support passage H.R.2013 Medicare Home Health Accessibility Act - support passage and introduction of similar bill in Senate H.R.1614, therapy telehealth act - support passage S.1261/H.R.4206 CONNECT for Health Act - advocate for provision to establish OTs as permanent Medicare telehealth providers No bill number - Asking for potential carve out of schools from Medicaid referral requirement S.2847/H.R.4037 Occupational Therapy Mental Health Parity Act - support passage H.R.4204 Medicare Patient Choice Act - support passage S.2329/H.R.4475 Medicare Orthotics and Prosthetics Patient-Centered Care Act - support passage S.2830 WELL Seniors Act - support passage S.2709/H.R.5081 Telehealth Modernization Act - support passage H.R.4559 Prompt and Fair Pay Act - support passage H.R.1171/S.2612 Stopping Addiction and Falls for the Elderly (SAFE) Act - support passage No bill number - Support legislation to repeal the Medicare Multiple Procedure Payment Reduction applied to therapy services. No bill number - Support legislation to make occupational therapy, physical therapy and speech language pathology a mandatory Medicaid benefit.

Client expense: $189,000 · Firm income: Not reported

Issues surrounding Medicare reimbursement and coverage denials Issues surrounding 2025 conversion factor and Medicare reimbursement reform (H.R. 3514/S.1816) Improving Seniors' Timely Access to Care Act (H.R. 1) One Big Beautiful Bill Act [P.L. No. 119-21] (H.R.4204) Medicare Patient Choice Act (H.R.4475/S.2329) Medicare Orthotics and Prosthetics Patient-Centered Care Act

Client expense: Not reported · Firm income: $30,000

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H.R.879 Medicare Patient Access and Practice Stabilization Act - support passage No bill number: Support an annual inflationary update or an increase for 2025 and 2026 to the Medicare Physician Fee Schedule No bill number: Support an extension of telehealth waivers under Medicare after the September 30, 2025 expiration, including in Continuing Resolutions. H.Con.Res.14 and H.R.1- ask Congress to limit cuts to state funding for Medicaid and limit burden when applying eligibility checks and requirements H.R.1171 Stopping Addiction and Falls for the Elderly Act (SAFE Act) - support passage H.R.2013 Medicare Home Health Accessibility Act - support passage and introduction of similar bill in Senate H.R.1614, therapy telehealth act - support passage S.1261 CONNECT for Health Act - advocate for provision to establish OTs as permanent Medicare telehealth providers No bill number: Asking for potential carve out of schools from Medicaid referral requirement S.2847/H.R.4037 Occupational Therapy Mental Health Parity Act - support passage H.R.4204 Medicare Patient Choice Act - support passage S.2329/H.R.4475 Medicare Orthotics and Prosthetics Patient-Centered Care Act - support passage S.2830 WELL Seniors Act - support passage S.2709/H.R.5081 Telehealth Modernization Act - support passage

Client expense: $189,000 · Firm income: Not reported

United Spinal continues to oppose H.R. 1, the One Big Beautiful Bill Act, for the adverse effects it will have on people with disabilities, especially in cutting Medicaid programs and benefits. United Spinal continues to advocate about the concerns we have about the major restructuring of the Department of Health and Human Services programs. We want to make sure that critical programs, services, and funding for the disability and aging communities, such as the Centers for Independent Living, Home and Community-Based Services and the National Institute for Disability, Independent Living, and Rehabilitation Research (NIDILRR) are not negatively impacted. Participated in NCARTs annual Fly In. Met with members of Congress/staff on the following issues: Supported timely wheelchair repairs legislation that is currently being drafted in the Senate. Supported S.247 and H.R.1703, Improving access to lightweight carbon fiber and titanium wheelchairs will allow individuals with mobility challenges to choose the wheelchair that is best suited for their medical, functional, and lifestyle needs and preferences, without increasing costs to the Medicare program. https://www.congress.gov/bill/119th-congress/house-bill/1703/all-info Advocated for Medicare coverage of power wheelchairs standing systems. Advocated for restoring federal appropriations for the Department of Defenses Spinal Cord Injury Research Program (SCIRP). Advocated for Congress extending the current telehealth provisions before the last deadline and also support H.R. 1614 to make physical therapists and occupational therapists permanently authorized providers of telehealth under Medicare. H.R. 1614, the Expand Practitioners Eligible to Furnish Telehealth Services Under the Medicare Program Act, introduced by Representatives Mike Kelly (R-PA), Mike Thompson (D-CA), and Adrian Smith (R-NE) has bipartisan support to eliminate the need for continued extensions, instructing Centers for Medicare and Medicaid Services to permanently adopt the temporary waiver of restrictions on payment for telehealth services delivered by physical therapists, occupational therapists, and other qualified healthcare. United Spinal supports H. R. 4475/S. 2329, the Medicare Orthotics and Prosthetics Patient-Centered Care Act. This bipartisan, bicameral bill will ensure Medicare beneficiaries can access the orthotics and prosthetics devices they need. Under current Medicare requirements, beneficiaries are at risk of receiving orthotic and prosthetic devices without the necessary services and customization required for the best use. The bill will clarify the law and permit Medicare beneficiaries who require prosthetics and orthotics to receive these important services. United Spinal advocacy and policy staff met with officials in the Department of Health and Human Services Administration for Community Living to express their concerns about proposed cuts to their budget and proposed departmental reorganization proposals. Staff stressed the importance of programs under the agency that serve people with disabilities. Discussed ways we could collaborate on highlighting the importance of the research completed enhancing peoples daily lives. United Spinal advocates for S. 1261, the CONNECT for Health Act, introduced by Senator Brian Schatz (D-HI) The CONNECT for Health Act will expand coverage of telehealth services through Medicare, make COVID-19 telehealth flexibilities permanent, improve health outcomes, and make it easier for patients to connect with their doctors. Current flexibilities are set to expire on September 30 unless Congress extends them.

Legislation and regulation that may impact the practice and/or the profession of orthotics and prosthetics; Issues pertaining to Medicare competitive bidding including an exemption for orthotists and prosthetists; Medicare regulations in regards to the reasonable useful lifetime of orthoses; Medicare fraud and abuse especially the elimination of drop shipping of OTS orthoses, and limiting the elimination/lowering of Medicaid access, Seeking exemption for tariffs on medical devices including orthotics and prosthetics. Specific bills include the Medicare Orthotics and Prosthetics Patient-Centered Care Act (H.R 4475, S.2329).

Client expense: $30,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Medicare Orthotics and Prosthetics Patient-Centered Care Act(H.R 4475, S.2329). Legislation and regulation that may impact the practice and/or the profession of orthotics and prosthetics. These issues include health insurance coverage issues, managed care, Medicare reform, fraud and abuse, reasonable useful lifetime (RUL) restrictions, and FDA issues (no specific bills).

Client expense: $30,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Issues surrounding Medicare reimbursement and coverage denials Issues surrounding 2025 conversion factor and Medicare reimbursement reform (H.R. 3514/S.1816) Improving Seniors' Timely Access to Care Act (H.R. 1) One Big Beautiful Bill Act [P.L. No. 119-21] (H.R.4204) Medicare Patient Choice Act (H.R.4475/S.2329) Medicare Orthotics and Prosthetics Patient-Centered Care Act

Client expense: Not reported · Firm income: $20,000

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H.R.879 Medicare Patient Access and Practice Stabilization Act - support passage No bill number: Support an annual inflationary update or an increase for 2025 and 2026 to the Medicare Physician Fee Schedule No bill number: Support an extension of telehealth waivers under Medicare after the September 30, 2025 expiration, including in Continuing Resolutions. H.Con.Res.14 and H.R.1- ask Congress to limit cuts to state funding for Medicaid and limit burden when applying eligibility checks and requirements H.R.1171 Stopping Addiction and Falls for the Elderly Act (SAFE Act) - support passage H.R.2013 Medicare Home Health Accessibility Act - support passage and introduction of similar bill in Senate H.R.1614, therapy telehealth act - support passage S.1261 CONNECT for Health Act - advocate for provision to establish OTs as permanent Medicare telehealth providers No bill number: Asking for potential carve out of schools from Medicaid referral requirement S.2847/H.R.4037 Occupational Therapy Mental Health Parity Act - support passage H.R.4204 Medicare Patient Choice Act - support passage S.2329/H.R.4475 Medicare Orthotics and Prosthetics Patient-Centered Care Act - support passage S.2830 WELL Seniors Act - support passage S.2709/H.R.5081 Telehealth Modernization Act - support passage

Client expense: $189,000 · Firm income: Not reported