; or (ii) in the case of a State that does not provide for the licensing of orthotists and prosthetists, is certified by the American Board of Certification in Orthotics, Prosthetics and Pedorthics, Inc. or by the Board of Certification/Accreditation, International, or is certified and approved by an entity that the Secretary determines has certification and approval standards that are essentially equivalent to the certification and approval standards of such Boards. . (2) Impact on DMEPOS benefit The amendment made by paragraph (1)— (A) shall not be construed to create a separate benefit category under title XVIII of the Social Security Act for orthotic and prosthetic devices; but (B) shall be construed as differentiating the manner in which orthotic and prosthetic devices and services are provided in contrast to other durable medical equipment and supplies services covered under such title. (c) Definition of orthotics and prosthetics synonymous with orthoses and prostheses Section 1834(h)(4)(C) of the Social Security Act ( 42 U.S.C. 1395m(h)(4)(C) ) is amended by inserting (which may also be referred to without distinction as orthoses and prostheses ) after the term orthotics and prosthetics . (d) Limitation of competitive acquisition for off-the-Shelf orthotics Section 1847(a)(7)(A)(i) of the Social Security Act ( 42 U.S.C. 1395w–3(a)(7)(A)(i) ) is amended— (1) by inserting , orthotist or prosthetist (as defined in section 1834(v)(5)(C)), after by a physician ; (2) by inserting , orthotist’s or prosthetist’s, after to the physician’s