20151030-medicare-v2

Medicare Issue Update

White House Announces Update on Medicare LCD Proposal

Your voices have been heard!! As a direct result of the over 100,000 signatures on the White House petition, the White House has informed us that the Medicare Contractors “will not finalize the draft Lower Limb Prostheses Local Coverage Determination (LCD) (DL33787) at this time.” The Amputee Coalition is extremely thankful to all of the individuals who took the time to get engaged and who spoke out against the recent proposal.

The White House also announced that CMS would establish a “Workgroup in 2016, comprised of clinicians, researchers, policy specialists and patient advocates from different federal agencies” to discuss future coverage policies for prosthetic limbs and amputee care. The Amputee Coalition will work hard to ensure the consumer voice is considered by this Workgroup. In addition, the Amputee Coalition is committed to working with amputees, prosthetists, physicians, and other rehabilitation professionals to bring together the external stakeholder perspective on this issue.

This is a win for the limb loss community, and this shows how strong our voice can be when everyone comes together!

But there is still more work to be done.

While this announcement today does not officially rescind the proposal, it is still a significant result. We are pleased with this decision today, however we also recognize that the issue is not going away and that Medicare is planning on convening a Workgroup to redraft a different proposal on lower limb prosthetic coverage.  We had recommended the Workgroup would include those from outside of the government, representing consumers and professionals who care for persons with limb loss on an everyday basis.  Given the fact that it is an internal government Workgroup, we must work hard to make certain that the needs of persons with limb loss are properly considered, and that the recommendations made by the Workgroup are appropriate and well informed.  The Amputee Coalition is looking forward to working with Medicare (CMS) and other stakeholders to improve appropriate access to amputee care and to work to ensure patients receive the most appropriate device at the most appropriate time.

Please know that without your assistance and determination to let CMS know that the LCD was bad policy for amputees, we wouldn’t have been able to celebrate this successful outcome. We will continue to keep you notified of updates on this issue as they occur, so be sure to check back to the http://www.amputee-coalition.org frequently.

White House issues initial response to LCD Petition

The Amputee Coalition’s comments in regard to the initial response

On October 16, the White House posted an “initial” response to the “We the People” petition that the Amputee Coalition and others used to raise awareness and rally the limb loss community against the proposed Medicare Local Coverage Determination (LCD) for Lower-Limb Prostheses.

The petition requested the president rescind the draft Medicare LCD for Lower-Limb Prostheses (DL 33787) and was consistent with the Amputee Coalition’s formal response to Medicare and the administration to rescind the proposal and meet with the Amputee Coalition, patients, experts and professionals from relevant organizations to better determine an appropriate path forward.

With your support, the petition garnered more than 109,000 signatures in less than 30 days, and we saw an unprecedented response from the limb loss community, which sent in more than 15,000 letters to the formal comment address, members of Congress, and the President’s Office on Disability.

While we are pleased to see this “initial” response to the “We the People” petition, and appreciate the White House’s commitment to respond to all petitions that receive more than 100,000 signatures, the Amputee Coalition continues to emphasize the need for a final determination that would instruct the DME MACs to rescind the draft LCD and meet with the appropriate group of patients and professionals.

This policy must be rescinded to mitigate the significant impact that the draft LCD proposal would have on patients’ ability to access appropriate prosthetic care with not only Medicare but also private payers. Private insurance has already followed proposals outlined in the draft LCD, with United Healthcare recently discontinuing coverage of active suction socket technology that was referenced in the draft Medicare policy.

The limb loss community has mounted an unprecedented response to the LCD, and the resounding response is that the LCD is bad policy, lacks clinical evidence, and contains significant changes in amputee care that would affect the ability for patients to receive the most appropriate device at the most appropriate time.

The Amputee Coalition will continue to work with Medicare, the administration, patients and professionals, to rescind the draft LCD, and lead an effort to bring together an appropriate group of patients and professionals to better determine an appropriate path for amputee care, rehabilitation and prosthetic device delivery.

To read the White House’s initial response to the petition, click here.

Amputee Coalition Works With Professionals and the O&P Industry to Issue a Joint Statement on the Initial WH Response; to read, click here

The Amputee Coalition is thankful to all of the individuals who took the time to get engaged and who spoke out against the recent Medicare Local Coverage Determination (LCD) proposal. The proposal was released on July 16, 2015, and a public comment period was available until August 31, 2015. While our voices have been heard, and thousands of individuals have submitted letters and signed petitions, we still need your help!

Coming soon, the Amputee Coalition will be providing a sample letter that you will be able to send to your members of Congress asking for their help. Even if you sent a letter during the public comment period in August, this letter will be different and will include a specific request as to how your elected officials can help, so we will be encouraging everyone to send the new letter to their elected officials once we post it.

We’ve provided information below about the proposal and what the Amputee Coalition has done on this important issue affecting the limb loss community.

Background and Frequently Asked Questions

The Amputee Coalition laid out several specific concerns with the proposal that would drastically impact amputees’ ability to receive the most appropriate prosthetic device at the most appropriate time. The concerns the Amputee Coalition outlined in the proposal included the following:

  • Medicare would 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 would be limited to less functional prosthetic devices. If you have a higher functional level, Medicare would 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 would not necessarily be able to select the necessary socket systems or liner inserts to ensure the most appropriate fit for your needs.
  • You would 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 referenced certain health complications.
  • The Medicare proposal would redefine the rehabilitation process for amputees and force new amputees to rehab on out-of-date technology that they would not even use once they received their permanent prosthetic device.

As a result of these concerns, the Amputee Coalition submitted formal comments during the open comment period and encouraged all of our members to help raise awareness and address these concerns with the proposal. The community overwhelmingly responded by signing a “We The People” White House Petition that garnered over 109,000 signatures in less than 30 days, and sent nearly 15,000 template letters to the formal comment mailbox and their elected officials. A public comment meeting was also held in Baltimore on August 26, 2015 that saw the community come together to voice their concerns. In a packed ballroom and with more than 400 attendees on a teleconference line, amputees, professionals, and organizations told the Medicare Contractors how serious this issue was for amputees and how powerful we are as a community.

Amputee Coalition’s response to the proposal

Throughout the process, the Amputee Coalition communicated to our members and the press about how this proposal would impact amputee care and saw more than 400 press hits nationwide and helped draw attention and raise awareness about the impacts this proposal would have on amputees.

Meetings the Amputee Coalition has had with officials about the proposal

Press releases from the Amputee Coalition about the proposal

Eblasts from the Amputee Coalition about the proposal

Finally, the Amputee Coalition developed the #NotALuxury campaign on social media that highlighted that prosthetic devices are not a luxury for amputees but are necessary to be able to remain active and independent members of their community. You can see the community’s response by going to https://twitter.com/hashtag/notaluxury and post your own comment!