For more recent news about what has happened since the public comment meeting on 8/26/15, the AOPA's September Monthly Recap provides this information: AOPA submitted 43 pages of comments on the draft policy, and over 5070 comments were submitted through AOPAvotes.org and the patient postcards sent to members.
AOPA organized a patient rally of 150 amputees at HHS headquarters and requested to meet with CMS officials, which led to a productive meeting of CMS top officials, AOPA and other stakeholders. Four AOPA representatives gave statements at the DME MAC open meeting. Over 350 news stories were generated from these efforts! Read about all of the August 26th events and the news articles here.
Previous text: Contractors of MEDICARE have recently issued a proposed new policy regarding patient eligibility and reimbursement for Lower Limb Prosthetics. This new policy, if enacted, would adversely impact the availability of prostheses to Medicare beneficiaries. And, soon thereafter, we believe that commercial insurances will follow with the same policies - as they usually do. This would touch everyone from children, to those affected by tragedies (such as veterans, cancer survivors and traumatic injuries), to the general population who may find themselves in need of prostheses. It would gravely impact both patients and the prosthetic profession--who deliver such highly unique and customized care to amputees.
The proposed changes, published July 16, 2015, take direct aim on disabled Americans' ability to qualify for prostheses. The proposal creates many troubling barriers that make it nearly impossible to qualify for anything other than very basic outdated limbs. It even would keep many amputees from using a prosthesis if they failed to meet the subjective standard of "the appearance of natural gait" while using the prosthesis. It would set back innovations and Research and Development completed over the past 50+ years, all done to help patients to return to their functional levels of mobility, improving their safety, quality of life, and pushing the envelope for some of the amazing athletes we have seen over the years. For all of these reasons, this draft policy must be defeated.
We are trying to fight this proposal and spread the word. Below are links with more information about the proposal, including a the actual coverage draft itself, the petition to the White House to rescind the proposal, as well as a letter drafted to amputees, explaining the implications of this proposed policy on their coverage for prosthetic limbs.
The draft policy:http://www.medicarenhic.com/viewdoc.aspx?id=3109
Petition the White House (this petition accumulated over 100,000 signatures in two weeks. We still need yours): https://petitions.whitehouse.gov/petition/rescind-medicare-proposal-restricting-access-prosthetic-limbs-and-returning-amputees-1970s-standards-care
Send a letter to Medicare: www.saveprosthetics.org
Letter to Amputees:http://mobilitysaves.org/2015/07/proposed-medicare-lower-limb-prosthesis-policy-will-significantly-limit-your-access-to-clinically-appropriate-and-medically-necessary-prosthetic-care/
Public Meeting 8/26/15: In addition, there will be a DME LCD Open Comment Meeting in Linthicum, MD on August 26th from 8AM - 12PM EST, where individuals will have the opportunity to express their concerns about the proposal: http://apps.ngsmedicare.com/ADC/EventList.aspx?fromdate=8/1/2015&todate=8/31/2015&display=Month&type=public&eventidn=3031&view=EventDetails&information_id=5739
Watch this YouTube video of a young man explaining how this policy would affect his father and their family should it become standard policy:https://www.youtube.com/watch?v=F-vX32AKvM0&feature=youtu.be
There are also a number of white papers which have been prepared for presentation to CMS about various aspects of the policy:
- Restrictive Devices: Penalizing Patients for Their Use of Assistive Devices During Gait after Lower Extremity Amputation
- Requiring "Demonstrated Performance" with Antiquated Prostheses to Qualify for a Modern Era Prosthesis
- Raising the Bar with a Shorter Pole: The Conflict of Requiring "Stability, Ease of Movement, Energy Efficiency and a Natural Gait" With a Basic Preparatory Device
- Inflating the indicators of "success" in the proposed LCD: Using maximal prerequisites to set minimum functional requirements
- Using Cognitive, Cardio-pulmonary and Neuromuscular Conditions to Disqualify Amputees for Prosthetic Care: By What Standards and with What Rationale
- The Proposed/Draft LCD creates "Improvement Standards," in Direct Violation of Jimmo v. Sebelius
- Tragic Timeline: Required Delays to Individualized Prosthetic Care
- Unable or Unwilling: Policy Discrimination against Bilateral Amputees and Other More Challenged Patients