PAYMENT FOR THERAPEUTIC SHOES FOR INDIVIDUALS WITH SEVERE DIABETIC FOOT DISEASE.

SEC. 4072. PAYMENT FOR THERAPEUTIC SHOES FOR INDIVIDUALS WITH SEVERE DIABETIC FOOT DISEASE. (a) Coverage Under Part B.— Section 1861(s) of the Social Security Act (42 U.S.C. 1395x(s)) is amended— (1) by redesignating paragraphs (12) through (15) as paragraphs (13) through (16), respectively, (2) by striking out “and” at the end of paragraph (10), (3) by striking out the period at the end of paragraph (11) and inserting “; and”, and (4) by inserting after paragraph (11) the following new paragraph: “(12) extra-depth shoes with inserts or custom molded shoes for an individual with diabetes, if— “(A) the physician who is managing the individual’s diabetic condition (i) documents that the individual has peripheral neuropathy with evidence of callus formation, a history of pre-ulcerative calluses, a history of previous ulceration, foot deformity, or previous amputation, or poor circulation, and (ii) certifies that the individual needs such shoes under a comprehensive plan of care related to the individual’s diabetic condition; “(B) the particular type of shoes are prescribed by a podiatrist or other qualified physician (as established by the Secretary); and “(C) the shoes are fitted and furnished by a podiatrist or other qualified individual (such as a pedorthist or orthotist, as established by the Secretary) who is not the physician101 STAT. 1330–117 described in subparagraph (A) (unless the Secretary finds that the physician is the only such qualified individual in the area).”. (b) Limitation on Benefit.— Section 1833 of such Act (42 U.S.C. 1395) is amended by inserting after subsection (e) the following new subsection: “(f) (1) In the case of shoes described in section 1861(s)(12)— “(A) no payment may be made under this part for the furnishing of more than one pair of shoes for any individual for any calendar year, and “(B) with respect to expenses incurred in any calendar year, no more than the limit established under paragraph (2) shall be considered as incurred expenses for purposes of subsections (a) and (b). Payment for shoes under this part shall be considered to include payment for any expenses for the fitting of such shoes. “(2) (A) Except as provided by the Secretary under subparagraphs (B) and (C), the limit established under this paragraph— “(i) for the furnishing of one pair of custom molded shoes is $300; “(ii) for the furnishing of extra-depth shoes and inserts is— “(I) $100 for the pair of shoes itself, and “(II) $50 for inserts for a pair of shoes. “(B) The Secretary or a carrier may establish limits for shoes that are lower than the limits established under subparagraph (A) if the Secretary finds that shoes and inserts of an appropriate quality are readily available at or below such lower limits. “(C) For each year after 1988, each dollar amount under subparagraph (A) or (B) (as previously adjusted under this subparagraph) shall be increased by the same percentage increase as the Secretary provides with respect to durable medical equipment for that year, except that if such increase is not a multiple of $1, it shall be rounded to the nearest multiple of $1. “(3) In this title, the term ‘shoes’ includes, except for purposes of subparagraphs (A)(ii) and (B) of paragraph (2), inserts for extra-depth shoes.”. (c) Modification of Exclusion.— Section 1862(a)(8) of such Act (42 U.S.C. 1395y(a)(8)) is amended by inserting “, other than shoes furnished pursuant to section 1861(s)(12)” before the semicolon. (d) Conforming Amendments.— Sections 1864(a), 1865(a), 1902(a)(9)(C), and 1915(a)(1)(B)(ii)(I) of such Act (42 U.S.C. 1395aa(a), 1395bb(a), 1396a(a)(9)(C), 1396n(a)(1)(B)(ii)(I)) are each amended by striking out “paragraphs (12) and (13)” and inserting “paragraphs (13) and (14)”. (e) Contingent Effective Date; Demonstration Project.— (1) The amendments made by this section shall become effective (if at all) in accordance with paragraph (2). (2) (A) The Secretary of Health and Human Services (in this paragraph referred to as the “Secretary”), shall establish a demonstration project to begin on October 1, 1988, to test the cost-effectiveness of furnishing therapeutic shoes under the medicare program to the extent provided under the amendments made by this section to a sample group of medicare beneficiaries. (B) (i) The demonstration project under subparagraph (A) shall be conducted for an initial period of 24 months. Not later than October 1, 1990, the Secretary shall report to the Congress on101 STAT. 1330–118 the results of such project. If the Secretary finds, on the basis of existing data, that furnishing therapeutic shoes under the medicare program to the extent provided under the amendments made by this section is cost-effective, the Secretary shall include such finding in such report, such project shall be discontinued, and the amendments made by this section shall become effective on November 1, 1990. (ii) If the Secretary determines that such finding cannot be made on the basis of existing data, such project shall continue for an additional 24 months. Not later than April 1, 1993, the Secretary shall submit a final report to the Congress on the results of such project. The amendments made by this section shall become effective on the first day of the first month to begin after such report is submitted to the Congress unless the report contains a finding by the Secretary that furnishing therapeutic shoes under the medicare program to the extent provided under the amendments made by this section is not cost-effective (in which case the amendments made by this section shall not become effective).