Updates on MEDICARE Proposal = Bad News for All Prosthesis Users

Important UPDATE:

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proposal creates many troubling barriers that make it nearly impossible to qualify for anything other than very basic outdated limbs.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:

 

Let your voice be heard!  Understand how you might lose a great deal of what you have gained with current technology and the relationship you have built with your prosthetist.  Act NOW!

Arms and Legs are #NotALuxury

As a prosthesis user, what do you do every day that you would find difficult to do without your prosthesis?  What is something you take care of daily that is not a luxury, or something you do often that you cannot imagine doing without - what are the things you take for granted you can do, as long as you have your prosthesis? Make the bed? Take care of your children? Your grandchildren?  Go to work?  Clean the house?  Mow the lawn? Walk your dog? Go to church? Grocery shop? Cook? Work out at the gym? Dance? Run?  

These are the kinds of things that the social media campaign #NotALuxury is trying to communicate to the Centers for Medicare & Medicaid Services (CMS) concerning the new Lower Limb Prosthetic proposal. Having access to the newest technology, not back to the 70’s tech, and access to your complete medical care team - including your prosthetist’s expert evaluation of your needs and prosthesis fabrication - these are things to fight for.  And, as we know, what Medicare does, other private insurers will follow with. No amputee is safe.

“Mommyblogger” Peggy, an amputee who blogs about her life as an amputee, started this social media campaign to encourage amputees to share a short 14 second video on their Facebook page, YouTube, Twitter, or any other social media they participate in - with the hashtag #NotALuxury.  Also, if you tweet, send it to @CMSgov - the official Twitter handle of the organization behind this proposal.  In her 8/6/15 blog post, Peggy describes fully the impact that this proposal would have on her life as a mother - how returning to old technology would impact her life as an amputee with an active child and an infant.  “We are looking for average activities, not super athletic feats. Whatever you are able to do because of your prosthesis, please film a clip. We want to flood social media with videos demonstrating the impact of a prosthesis on regular life. “

The Amputee Coalition also states on their website “The Amputee Coalition has always maintained that arms and legs are not a luxury and shouldn’t be treated as such. If you’re interested in sharing your concerns about this draft proposal, the Amputee Coalition encourages you to use #NotALuxury on all social media posts about this issue so we can show a unified and cohesive voice.”  They sum up the proposed policy on their website:

  • Medicare will no longer consider your potential functional abilities with an appropriate device when determining your prosthetic needs.
  • If you are using an assistive device such as a cane, crutch or walker, you will be limited to less functional prosthetic devices. If you have a higher functional level, Medicare will not pay for you to have a wheelchair.
  • Combining feet and ankles into a single code and limiting access to advanced technology would significantly harm your access to the feet and ankles that best meet your individual needs.
  • You and your medical team may no longer be able to select the necessary socket systems or liner inserts to ensure the most appropriate fit for your needs.
  • You could be provided a less functional prosthesis or denied a device just because you may not be able to attain the “appearance of a natural gait,” or if your medical record references certain health complications.
  • The Medicare proposal redefines the rehabilitation process for amputees and forces new amputees to rehab on out-of-date technology that they will not even use once they receive their permanent prosthetic device.

So, let your inner filmmaker - screenwriter/director/actor - get out there and make a short video, or make several! Spread the word to other amputees you know to also make one.  

You can make a difference in your care.