The more NAAOP reads of the proposed draft Local Coverage Determination (“LCD”) for Lower Limb Prostheses found at http://www.medicarenhic.com/viewdoc.aspx?id=3109, which was issued by the DME MACs two weeks ago, the more alarming the proposed policy becomes.
This is a tour de force of bad Medicare policy that will literally harm patients. The proposed policy is supported by virtually no evidence, will set the standard of care back by decades, and appears to be motivated by a misguided attempt to save money to the detriment of amputees and the providers who serve them. The draft LCD must be rescinded in its entirety. No amount of tweaking will improve this policy.
Request to Rescind the LCD: On Friday, July 31st, NAAOP joined with other members of the O&P Alliance in writing to CMS Acting Administrator Andy Slavitt requesting this policy be rescinded. In the alternative, the letter requested an indefinite suspension of the draft policy until a more rational and transparent process could be established to address CMS’s concerns with lower limb prostheses. We requested a national meeting at CMS solely devoted to this LCD and a suspension of the LCD at least until such time as CMS issues a final rule on prior authorization, which is pending final publication in the next few months.
Online Petition: In addition, NAAOP has initiated a “WE THE PEOPLE” online petition on the White House website. We need 100,000 signatures by the end of August in order for the White House to officially respond. ALL NAAOP members, friends, family members, employees and patients should be encouraged to sign this online petition. It takes three minutes and can be found at http://wh.gov/iIIoi. Please do everything you can to help rescind this restrictive and unfair Medicare policy.
Public Comments: Public comments on this proposed policy are due by August 31, 2015. NAAOP is working with the O&P Alliance to draft a comprehensive set of comments. We will also be posting sample comments on our website for our members and friends to use as templates in drafting their own comments to the DME MACs, which we strongly encourage. Templates can be useful to assist with these submissions, but your personal comments and reactions to this policy from a clinical or patient standpoint are critical. There will also be a public meeting on August 26th in Linthicum, Maryland on this policy.
The proposed LCD is a comprehensive re-write of the existing LCDs, addressing all aspects of coding, coverage, and payment of lower limb prostheses for Medicare beneficiaries. The draft LCD is highly restrictive and returns the Medicare prosthetic benefit to a 1970’s standard of care. Because many of the proposed changes involve the Uniform Code Set, which applies to all payers, these policies once finalized are likely to impact all amputees using prostheses. Many of the changes proposed in the draft LCD raise serious concerns for patients, prosthetists, physicians, and other health care providers and suppliers caring for patients with lower limb amputations.
The fate of prosthetic care in this country hangs in the balance. Thank you for your continued participation and support.