Medicare, through its contractors, has proposed new coverage, coding, and clinical care guidelines that would have a profoundly negative impact on amputees across the United States.
If implemented, the policy installs new barriers that would limit and potentially deny access to appropriate prosthetic care. It eliminates coverage for certain prosthetic devices that amputees depend on for every step they take every day. It even would preclude amputees from using a prosthesis if they failed to meet the entirely nebulous and subjective standard of "the appearance of natural gait" while using the prosthesis.
Equally troublesome, the proposed policy contains no references to clinical or medical evidence supporting the changes.
For all of these reasons, the draft policy should be rescinded.
Response to Petition
Thanks for using We the People, and for sharing your concerns about the local coverage determination for lower limb prostheses proposed by Medicare contractors. In order to get the most up-to-date information concerning your petition, we've gone to the Department of Health and Human Services (HHS) -- specifically, the Centers for Medicare and Medicaid Services (CMS), and the Administration for Community Living (ACL).
The coverage determination process is still ongoing, but CMS wants to make clear that they’re committed to providing high quality care to all Medicare beneficiaries. They also wanted to make sure you know that HHS has met with stakeholders on this important issue, and both CMS and its contractors understand the questions that have been raised about access to the right prosthetic care -- including related technologies -- for Medicare beneficiaries.
We will be in touch with another update.
--The We the People Team
An updated response to your petition on a Medicare local coverage determination:
A couple weeks ago, we passed along an initial response to your petition. Today, there's more to say. The Centers for Medicare & Medicaid Services (CMS) -- the relevant body within the federal government responsible for addressing this issue -- announced that the Durable Medical Equipment Medicare Administrative Contractors (DME MACs) will not finalize the draft Lower Limb Prostheses Local Coverage Determination (LCD) (DL33787) at this time. You can read the official announcement here.
Here's what else they'd like you to know:
CMS is committed to providing high quality care to all Medicare beneficiaries, including any beneficiary in need of a prosthesis. Both CMS and its contractors have heard your concerns about access to prostheses for Medicare beneficiaries.
After a preliminary review of the public comments, CMS is convening a multidisciplinary Lower Limb Prostheses Interagency Workgroup (Workgroup) in 2016. The purpose of the Workgroup is to develop a consensus statement that informs Medicare policy by reviewing the available clinical evidence that defines best practices in the care of beneficiaries who require lower limb prostheses. The Workgroup will be comprised of clinicians, researchers, and policy specialists from different federal agencies. The Workgroup may also identify areas where evidence gaps exist related to the prescription of lower extremity prostheses, and make recommendations concerning the study designs and outcome measures that best inform patient oriented function, quality of life, and service satisfaction in this realm. CMS will ensure there is opportunity for public comment and engagement on the Workgroup consensus statement and any related activities.
The federal government looks forward to working with the public to ensure appropriate access to prostheses.
Thanks so much for raising your voice around this issue -- and for your continued advocacy around it.
The We the People Team