As of July 16, 2015, potential alterations to Medicare coverage of lower limb prostheses may prevent appropriate patient care for lower limb amputees. The Centers for Medicare & Medicaid Services released a new draft for the local coverage determinations (LCD) regarding lower limb prosthetic devices that will make it more difficult for current and future patients to receive coverage for various prosthetic components.
Among the changes to the LCD is the revision of functional level modifiers. According to the new draft, a prosthesis is only considered medically necessary if the device provides a patient with the appearance of a natural gait. This is discriminatory to patients who gain excellent mobility through the use of a device, but cannot attain visibly natural gait due to the nature of their disability. Furthermore, the draft eliminates patient potential from the functional level categories, meaning that patients who are progressing in their functional abilities are prevented from receiving higher functional level componentry. Yet the most worrisome aspect of the policy may be that patients who have utilized Medicare payment for any form of mobility aid (including canes, crutches, walkers, etc.) will be severely limited in their ability to receive higher quality prosthetic components. Instead of permitting patients to improve functional abilities, the policy actually inhibits patients from receiving the care necessary to maximize mobility.
In addition, the new LCD policy implements a number of other coverage limitations and patient requirements that delay or prevent appropriate prosthetic delivery. We encourage you to read a summary of the proposed LCD here: http://www.aopanet.org/2015/07/update-aopas-analysis-of-proposed-lower-limb-prosthetic-policy/ or the entire proposal here: http://www.medicarenhic.com/viewdoc.aspx?id=3109. The National Association for the Advancement of Orthotics & Prosthetics (NAAOP) created a petition calling for the policy to be rescinded. In order to receive a response from the White House staff, the petition needed to reach 100,000 signatures by August 31. The petition has already surpassed this requirement, though you may still contribute your signature here: https://petitions.whitehouse.gov//petition/rescind-medicare-proposal-restricting-access-prosthetic-limbs-and-returning-amputees-1970s-standards-care. The expression of your opinions and concerns can help prevent the implementation of this policy and can help patients across the country continue to receive the prosthetics care that they need and deserve. As we wait for a response from the White House, please provide your own thoughts about the policy here: https://aopa.wufoo.com/forms/comment-on-draft-policy-for-lower-limb-prostheses/, as they may be included in the American Orthotic & Prosthetic Association’s comments on the issue. All public comments on the proposed policy are due by August, 31, 2015.