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2016 Draft LCD Updates

The July 2015 LCD Draft proposal that would have limited access to prosthetic care for Medicare patients generated a flurry of activity by organizations serving the prosthetic community, patients, and other advocates. The LCD was not enacted but CMS began the process of  convening a workgroup of clinicians, researchers, and policy specialists to develop a consensus statement. The effects of the LCD have already been felt in the private sector, as several insurers removed coverage for vacuum pumps (as in the LCD) following the proposal. For this reason, an official rescission of the LCD remains a high priority for the O&P community.

In June 2016, as a result of the series of actions taken by the American Orthotic & Prosthetic Association (AOPA), important language was inserted into the Committee report which has been prepared to explain the 2017 Senate Labor/HHS Appropriations Bill.  This is an important directive to CMS, essentially that in light of reductions in Medicare prosthetic spend over 2012-2014, there seems no necessity for intervention to change the LCD, and instructing CMS to consult with clinicians, patients and prosthetist groups before releasing any new or revised version of the LCD.

The language included in the report is as follows:

“The Committee recognizes that Medicare payments for all prosthetics, and especially the newer advanced technologies, have declined over each of the years 2010-2014.  The committee encourages CMS to consult broadly with clinicians, patient groups, and the prosthetics field regarding revisions to the draft Local Coverage Determination, prior to publishing an updated draft policy for public comment.”

One of the events leading to this inclusion in the report was a series of meetings between Prosthetist Tom Watson and Sen. Majority Leader Mitch McConnell. Read the letter sent from Sen. McConnell to CMS’ Acting Director Andy Slavitt.

On April 21, 2016, AOPA held a press conference call to discuss the impact that CMS’ proposed Lower Limb LCD is having in the private sector. Media participants heard from AOPA President Elect Michael Oros, CPO, FAAOP and two amputees who have been affected by the new policies. Listen to the audio from the call and the press release summarizing the call.

On April 25, Rep. Renee Ellmers (R-NC) and Rep. Jan Schakowsky (D-IL) introduced H.R. 5045, a bill that would establish a moratorium on any action on the LCD through Spring 2017 and remove the withdrawn LCD from the CMS and DME MAC websites and establishing that, contrary to some legal interpretations at HHS, CMS indeed can, and is obliged to manage and instruct its contractors what to do across topics including LCD issues.

The next day, the first fruits of a months-long effort spearheaded by AOPA appeared as the House Oversight and Government Reform Committee released a letter it has initiated to HHS Secretary Sylvia Mathews Burwell, criticizing the prosthetic LCD efforts of CMS and its contractors, and launching an oversight inquiry with a request for a substantial collection of documents.
We will keep everyone updated on any further developments.