Your Voices Were Heard!!!….Medicare Pulls Back from the Draft Lower Limb Prosthetic Policy

Protest PictureOn July 16, 2015, the four DME MACs simultaneously released a draft LCD and Policy Article that proposed major changes to Medicare coverage rules for lower limb prostheses. The proposed changes were so detrimental to the provision of quality prosthetic care for Medicare amputee beneficiaries that the response from all sides of the prosthetic community, from patients, to providers, to researchers and physicians, was instantaneous and unanimous. There was a broad consensus that the draft policy, as it was written, was simply unacceptable and must be rescinded immediately.

Since the release of the draft LCD and Policy Article, AOPA and its partners, including the O&P Alliance and the Amputee Coalition, have worked tirelessly to educate patients, referral sources, Congressional representatives, and CMS officials on the potentially devastating impact the proposed policy would have on the provision of clinically appropriate prosthetic care to Medicare beneficiaries. Highlights of these efforts included more than 1,000 comment letters from O&P facilities, more than 2,000 comment letters from Medicare beneficiaries, an extremely effective public demonstration at the headquarters of the Department of Health and Human Services, support from multiple Congressional offices, multiple meetings and correspondence with high ranking CMS officials, and a “We The People” White House petition that garnered more than 100,000 signatures in 17 days, requiring a formal response from the Obama administration.

Those efforts bore significant fruit yesterday when the White House and CMS simultaneously announced that the draft LCD and Policy Article would not be finalized “at this time.” The announcement went on to explain that an interagency, multi-disciplinary workgroup composed of federal employees would be formed in 2016 that will review existing research and evidence, identify gaps in knowledge, and develop a consensus statement that will be used to help develop future policy.

While AOPA continues to believe that a full rescission of the draft LCD and Policy Article is the most appropriate action to ensure that Medicare beneficiaries continue to have access to the highest quality of prosthetic care, the decision to not publish the draft LCD and Policy Article in final form shows that when many voices cry out in unison, they cannot be ignored.

Despite the fact that many questions regarding the future of Medicare policy governing coverage of lower limb prostheses, It was a good day for O&P!

AOPA’s Take. Where You Go…….When You Need to Know!!!