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Draft Prosthetic LCD Will NOT be Finalized! More Work Required to Arrive at Appropriate Medicare Cov

After spending weeks waiting for the White House to respond to the NAAOP-created “We the People” Petition calling on the President to rescind the draft Local Coverage Determination (LCD) for Lower Limb Prostheses, NAAOP is pleased that the Centers for Medicare and Medicaid Services (CMS) WILL NOT FINALIZE the flawed draft LCD! This removes the immediate threat that this unwarranted and poorly-supported policy posed to patient access to modern prosthetic care. Derailing the draft LCD was Job One for NAAOP, other organizations in the prosthetic, rehabilitation and disability communities, and thousands of individuals who united to express their concerns. The controversial draft LCD generated over 100,000 petition signatures in just 17 days this past August, obligating the White House to formally respond. Considering how rare it is for CMS to reconsider LCDs, this is an important short-term victory. But our work on this issue is far from over.

While the draft LCD is essentially on hold, CMS will convene a multidisciplinary “Lower Limb Prostheses Interagency Workgroup” in 2016. The Workgroup will be comprised solely of federal employees from various agencies with some familiarity with limb prosthetics. The Workgroup is charged with developing a consensus statement that informs Medicare policy by reviewing the available clinical evidence that defines best practices in the care of beneficiaries who require lower limb prostheses. The Workgroup will also seek to identify evidence gaps and recommend study designs and outcome measures that inform function, quality of life and service satisfaction in this area.

Patients and providers from outside the government will not be included in the Workgroup. This is because of federal rules that prohibit private citizens from serving on advisory panels in most circumstances. But the White House and CMS statements say that they “will ensure there is opportunity for public comment and engagement” with the Workgroup’s activities. A meeting is already being set up with CMS officials to explore how the public will be able to impact the deliberations of the Workgroup.

The meeting will also include discussions designed to ensure that CMS and its contractors remove the draft LCD from their websites so that private insurers and other payers do not adopt draft CMS p.olicy as if it were final coverage policy. Unfortunately, this already occurred in September when United Healthcare discontinued coverage for vacuum socket technology just seven days after the comment period on the draft LCD ended. For this reason, NAAOP intends to continue pressing CMS and its contractors to formally rescind the draft LCD.

The White House/CMS announcements are a major first step forward and we commend them for listening to our concerns and putting a stop to the draft LCD. The decision underscores how patients with limb loss, prosthetists, physicians, rehabilitation providers, and members of the disability community can band together to effect positive change. NAAOP would like to thank its board of directors and members, O&P Alliance partners, the Amputee Coalition, thousands of individuals, other organizations, O&P clinics, providers, manufacturers, researchers and educators for their collective efforts to challenge the draft LCD.

Contact Peter Thomas at 202-455-6550 or for further information.

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