Bill > SB537

This bill amends the Human Services Code to establish new requirements for medical assistance payments for orthotics and prosthetics. Specifically, the bill mandates that the state department must set reimbursement rates for custom prosthetic and orthotic items and services under the medical assistance fee-for-service program at a level no less than the current quarter's Medicare Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Fee Schedule established by the Centers for Medicare and Medicaid Services (CMS). The bill also requires the department to update its medical assistance program to include all codes for custom prosthetic and orthotic items and services found in the current CMS fee schedule. The legislation includes a provision clarifying that these new requirements do not override existing regulations related to medical practice. The bill will take effect 60 days after its enactment, with the goal of ensuring that medical assistance recipients have access to necessary orthotic and prosthetic services at rates consistent with Medicare standards.

Health and Social Services

https://www.legis.state.pa.us/cfdocs/billinfo/bill_history.cfm?syear=2025&sind=0&body=S&type=B&bn=537