The VA has Changed Reimbursement Rules for Prosthetics

The Department of Veterans Affairs has unilaterally decided to assign reimbursement amounts to prosthetic feet that are not consistent with the Center for Medicare Services. As a result of their action, veterans do not have the same access to certain prosthetic feet that those with Medicare, Medicaid, and private insurance receive.

Read the letter from five Congressional members to the Secretary of the VA.

Take action now! Take a few minutes to send a prewritten letter to your representatives in Congress.

Veterans – use this letter.

Practitioners – use this letter.

Anyone else can click on one of the links above and customize the letter to your own circumstances.



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.

Prosthetist Speaks to United Nations, Highlighting Value and Potential of 3-D Printing Technology in Third World Environments Where Access to Traditional Components is Limited, and in Mass Injuries

Jeff Erenstone, CPO

Jeff Erenstone, CPO, President of Create Prosthetics and member of the eNABLE Advisory Boards, addressed the United Nations, during a panel headed by the UN ambassador of Iraq and sponsored by UN Mine Action Service (UNMAS) about the value and potential of 3D printed prosthetics in Third World Environments and conflict zones.  He discussed the evolution of 3D printed prosthetics from “over hyped” plastic toys to devices that, when properly constructed in accordance with all FDA regulatory controls may be considered medical grade.  He shared his experience with recent efforts in Haiti and how his team focused on educating the local prosthetists on this technology and giving them the control over deciding if a 3D printed device is appropriate or to stick with a more conventional device.

Part of his address included one of the great benefits of 3D printed devices – that the components can be fabricated on-site.  This is especially valuable in conflict zones where shipping supplies is especially difficult. He plans continue to talk with UNMAS about their efforts to deploy relatively low cost 3D printed devices in Iraq and Syria.

Other panelists included the Ambassador of Iraq, who spoke about the great need for long term care of IED victims in north Iraq.  The UNMAS representative supported the information provided by the Ambassador and explained the actions that UNMAS are taking to deal with this area and other areas around the map.  Ned Norton of the Hercules Project also addressed the UN, as he has been working to supply people in conflict zones physical therapy free to people with disabilities.

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Cutting Edge Lower Limb Prosthetics

Touching Video of Girl Receiving Doll with Matching Prosthetic Leg

Update on CMS’ Lower Limb Prosthetics Policy

The July 16, 2015 Local Coverage Determination (LCD) Lower Limb Prostheses policy that was proposed would have reverted patient care to a 1970’s standard. O&P organizations and patients joined to object to the policy, in the form of a White House petition, comments submitted to CMS, testimony at the hearing, letters from researchers whose work was cited, a rally in front of the HHS headquarters, meetings with CMS, etc. (Read all the actions taken.)

The policy was not enacted but it has not been removed from the website of CMS and its contractors, so O&P advocates have continued to voice their objections. On April 28, after efforts from the American Orthotic & Prosthetic Association, the House Oversight and Government Reform Committee released a letter 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 post updates of progress.

On April 26-27, O&P professionals, students, and patients visited Capitol Hill to meet with legislators to advocate for fair treatment of O&P providers and patients. One clinician met with Senate Majority Leader, Mitch McConnell (R-KY), who then authorized a letter to CMS Acting Administrator, Andy Slavitt regarding the 2015 LCD Policy, its status, and the workgroup that has been assembled to evaluate CMS’ O&P policy. Read the letter from Sen. McConnell to Andy Slavitt. AOPA will post any further correspondence.


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Adrianne Haslet-Davis Running Boston Marathon

Adrianne Haslet-Davis, who lost her leg as a spectator during the Boston marathon bombing in 2013, is returning as a participant. She’s running on behalf of the nonprofit Limbs for Life, raising money — over $14,000 so far — to provide prosthetic limbs for those that need but can’t afford them.CgHCGuMUsAAW-z5

In 2015, Adrianne, a professional ballroom dancer, danced across the finish line.


In 2014, she walked across the finish line with her 2 brothers who ran the marathon.

Boston Marathon Amputee Dancer

Boston Marathon survivor Adrianne Haslet-Davis throws out the first pitch at Fenway Park

Adrianne Haslet-Davis, Boston Marathon bombing survivor and amputee, throws out the first pitch before the Blue Jays play the Red Sox at Fenway Park on April 15, 2016. April 15 is “One Boston Day”, to celebrate the resiliency, generosity, and strength demonstrated by the people of Boston and those around the world in response to the tragedy of April 15th, 2013.
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Adrianne Haslet-Davis: Why Congress And Medicare Doesn’t Like Me

Update on Prior Authorization – When Will it Affect Patients?

The Centers for Medicare & Medicaid Services (CMS) issued a final rule December 29, 2015 that would require patients to obtain Prior Authorization for most lower limb prosthetics.

However, it may be a while before patients will need to obtain prior authorization before receiving prosthetic care. While the rule is in place beginning February 2016, we have some indications that: (1) CMS is more likely to take an incremental approach—regional steps with a limited number of devices seems more likely than a national rollout on all prosthetics; (2) CMS may be interested to see how the draft LCD follow-up proceeds before rolling out prosthetic Prior Authorization; (3) they pledge to take steps to avoid delay in patient access to care, and to try to minimize, if not eliminate the prospect that there are post-payment audits on medical necessity issues after a Prior Authorization has been secured, which could push the date for implementation of Prior Authorization for prosthetics 6 -12 months later.

While AOPA is still concerned that the prior authorization process will delay patient access to prosthetic devices, providers will have more time to prepare than initially expected, and should be able to comply with this new rule by the time it affects patients.  Since prior authorization is premised explicitly on the need to control unnecessary or excessive utilization, clearly those classes of devices showing -40+{cd9c44e368fb6cee2d09ae9816b0d094fbe47d90389af7031507558183226368} reduction in utilization since 2010 (K3 and K4 advanced prosthetics) should not be on the list of codes subject to prior authorization.