What This Bill Does
This bill makes changes to Medicaid and Medicare programs involving foot and ankle care. It allows doctors of podiatric medicine (foot doctors) to be recognized as physicians under Medicaid and modifies the requirements for diabetic shoes covered by Medicare.
Who It Affects
Medicaid beneficiaries who need foot and ankle care, people with diabetes who need therapeutic shoes under Medicare, podiatric physicians (foot doctors), other qualified physicians, pedorthists and orthotists (shoe specialists), and Medicaid providers and suppliers.
Key Provisions
- Doctors of podiatric medicine are recognized as physicians under Medicaid so they can deliver physician services to Medicaid beneficiaries for foot and ankle care (Sec. 2)
- The physician managing a patient's diabetes must document the diabetes, certify the patient is under a comprehensive care plan for diabetes, and document agreement that therapeutic shoes are medically necessary (Sec. 3)
- A podiatrist or other qualified physician must examine the patient, determine medical necessity for therapeutic shoes, and communicate findings in writing to a doctor of medicine or osteopathy (Sec. 3)
- Therapeutic shoes must be fitted and furnished by a podiatrist or other qualified supplier like a pedorthist or orthotist, unless the Secretary determines no other qualified person is available in the area (Sec. 3)
- Medicaid provider and supplier payments can be subject to continuous levy to strengthen program integrity (Sec. 4)
What Changes
Podiatric physicians gain recognition as physicians under Medicaid starting January 1, 2024. Medicare's requirements for covering diabetic therapeutic shoes change to involve podiatrists and other qualified physicians in the prescription process, starting January 1, 2024. The bill allows the government to levy payments to Medicaid providers and suppliers to enforce tax debts, effective after the bill is signed into law.
Important Definitions
Therapeutic shoes are extra-depth shoes with inserts or custom molded shoes with inserts for individuals with diabetes.
Effective Date
January 1, 2024 for Medicaid podiatric physician coverage and Medicare diabetic shoe requirements. Levies on Medicaid payments are effective after the bill is signed into law.
I
118TH CONGRESS
1ST SESSION H. R. 1634
To amend title XIX of the Social Security Act to cover physician services
delivered by podiatric physicians to ensure access by Medicaid bene-
ficiaries to appropriate quality foot and ankle care, to amend title XVIII
of such Act to modify the requirements for diabetic shoes to be included
under Medicare, and for other purposes.
IN THE HOUSE OF REPRESENTATIVES
MARCH 17, 2023
Mr. JOHNSON of Ohio (for himself and Ms. DEGETTE) introduced the fol-
lowing bill; which was referred to the Committee on Energy and Com-
merce, and in addition to the Committee on Ways and Means, for a pe-
riod to be subsequently determined by the Speaker, in each case for con-
sideration of such provisions as fall within the jurisdiction of the com-
mittee concerned
A BILL
To amend title XIX of the Social Security Act to cover
physician services delivered by podiatric physicians to
ensure access by Medicaid beneficiaries to appropriate
quality foot and ankle care, to amend title XVIII of
such Act to modify the requirements for diabetic shoes
to be included under Medicare, and for other purposes.
Be it enacted by the Senate and House of Representa-
1
tives of the United States of America in Congress assembled,
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SECTION 1. SHORT TITLE.
1
This Act may be cited as the ‘‘Helping Ensure Life-
2
and Limb-Saving Access to Podiatric Physicians Act’’ or
3
the ‘‘HELLPP Act’’.
4
SEC. 2. RECOGNIZING DOCTORS OF PODIATRIC MEDICINE
5
AS PHYSICIANS UNDER THE MEDICAID PRO-
6
GRAM.
7
(a) IN GENERAL.—Section 1905(a)(5)(A) of the So-
8
cial Security Act (42 U.S.C. 1396d(a)(5)(A)) is amended
9
by striking ‘‘section 1861(r)(1)’’ and inserting ‘‘para-
10
graphs (1) and (3) of section 1861(r)’’.
11
(b) EFFECTIVE DATE.—
12
(1) IN GENERAL.—Except as provided in para-
13
graph (2), the amendment made by subsection (a)
14
shall apply to services furnished on or after January
15
1, 2024.
16
(2) EXTENSION
OF
EFFECTIVE
DATE
FOR
17
STATE LAW AMENDMENT.—In the case of a State
18
plan under title XIX of the Social Security Act (42
19
U.S.C. 1396 et seq.) which the Secretary of Health
20
and Human Services determines requires State legis-
21
lation in order for the plan to meet the additional
22
requirement imposed by the amendment made by
23
subsection (a), the State plan shall not be regarded
24
as failing to comply with the requirements of such
25
title solely on the basis of its failure to meet these
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additional requirements before the first day of the
1
first calendar quarter beginning after the close of
2
the first regular session of the State legislature that
3
begins after the date of enactment of this Act. For
4
purposes of the previous sentence, in the case of a
5
State that has a 2-year legislative session, each year
6
of the session is considered to be a separate regular
7
session of the State legislature.
8
SEC. 3. CLARIFYING MEDICARE DOCUMENTATION RE-
9
QUIREMENTS FOR THERAPEUTIC SHOES FOR
10
PERSONS WITH DIABETES.
11
(a) IN GENERAL.—Section 1861(s)(12) of the Social
12
Security Act (42 U.S.C. 1395x(s)(12)) is amended to read
13
as follows:
14
‘‘(12) subject to section 4072(e) of the Omni-
15
bus Budget Reconciliation Act of 1987, extra-depth
16
shoes with inserts or custom molded shoes with in-
17
serts (in this paragraph referred to as ‘therapeutic
18
shoes’) for an individual with diabetes, if—
19
‘‘(A) the physician who is managing the in-
20
dividual’s diabetic condition—
21
‘‘(i) documents that the individual has
22
diabetes;
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•HR 1634 IH
‘‘(ii) certifies that the individual is
1
under a comprehensive plan of care related
2
to the individual’s diabetic condition; and
3
‘‘(iii) documents agreement with the
4
prescribing podiatrist or other qualified
5
physician (as established by the Secretary)
6
that it is medically necessary for the indi-
7
vidual to have therapeutic shoes;
8
‘‘(B) the therapeutic shoes are prescribed
9
by a podiatrist or other qualified physician (as
10
established by the Secretary) who—
11
‘‘(i) examines the individual and de-
12
termines the medical necessity for the indi-
13
vidual to receive the therapeutic shoes; and
14
‘‘(ii) communicates in writing the
15
medical necessity to a certifying doctor of
16
medicine or osteopathy for the individual
17
to have therapeutic shoes along with find-
18
ings that the individual has peripheral neu-
19
ropathy with evidence of callus formation,
20
a history of pre-ulcerative calluses, a his-
21
tory of previous ulceration, foot deformity,
22
previous amputation, or poor circulation;
23
and
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‘‘(C) the therapeutic shoes are fitted and
1
furnished by a podiatrist or other qualified sup-
2
plier individual (as established by the Sec-
3
retary), such as a pedorthist or orthotist, who
4
is not the physician described in subparagraph
5
(A) (unless the Secretary finds that the physi-
6
cian is the only such qualified individual in the
7
area);’’.
8
(b) EFFECTIVE DATE.—The amendment made by
9
subsection (a) shall apply with respect to items and serv-
10
ices furnished on or after January 1, 2024.
11
(c) RULE OF CONSTRUCTION.—Nothing in this sec-
12
tion shall be construed as expanding Medicare coverage
13
for therapeutic shoes for individuals with diabetes.
14
SEC. 4. BUDGET SAVINGS: STRENGTHENING MEDICAID
15
PROGRAM
INTEGRITY
THROUGH
CONTIN-
16
UOUS LEVY ON PAYMENTS TO MEDICAID
17
PROVIDERS AND SUPPLIERS.
18
(a) IN GENERAL.—Section 6331(h)(2) of the Inter-
19
nal Revenue Code of 1986 (defining specified payment)
20
is amended by striking ‘‘and’’ at the end of subparagraph
21
(B), by striking the period at the end of subparagraph
22
(C) and inserting ‘‘, and’’, and by adding at the end the
23
following new subparagraph:
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‘‘(D) any payment to any Medicaid pro-
1
vider or supplier under a State plan under title
2
XIX of the Social Security Act.’’.
3
(b) EFFECTIVE DATE.—The amendments made by
4
this section shall apply to levies issued after the date of
5
the enactment of this Act.
6
Æ
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