CMS confirmed it will drop many of its recently proposed requirements in Medicare coverage that would have restricted access to modern prosthetic care for approximately 150,000 Medicare beneficiaries in need of lower limb prosthetics
As co-chairs of the Senate Medical Technology Caucus, Klobuchar and Coats sent a letter to the Centers for Medicare and Medicaid Services in September expressing serious concern that these restrictions would significantly diminish the quality of life for people who have sustained limb loss
WASHINGTON, DC – After an effort from U.S. Senators Amy Klobuchar (D-MN) and Dan Coats (R-IN), the Centers for Medicare and Medicaid Services (CMS) released a final rule confirming that it will drop the proposed restrictions on payments for prosthetics. In a letter to CMS that Klobuchar and Coats sent in September, the co-chairs of the Senate Medical Technology Caucus expressed serious concern that these restrictions would significantly diminish the quality of life for people who have sustained limb loss. In November, CMS announced it would reconsider the proposed changes after receiving over a thousand comments from concerned beneficiaries, advocacy groups, clinicians, and other interested parties.
“This announcement is a major victory for the approximately 150,000 Americans who need lower limb prosthetics under Medicare,” Klobuchar said. “This proposal would have restricted access to modern prosthetic care and decreased the quality of life for those whom have endured limb loss. I am glad that CMS rolled back these proposed restrictions so that amputees can have access to the devices that best meet their needs.”
“These proposed restrictions would have significantly diminished the quality of life for those who have sustained limb loss,” said Coats. “This is the right move, as amputees should not be denied access to modern prostheses care by Medicare.”
The proposed changes, which were announced in July, would have required a medical exam by a doctor or health professional other than a prosthetics expert to determine functionality, as well as impose stronger restrictions for patients to qualify for high-tech devices. These coverage changes would have placed limits on an amputee’s access to appropriate prosthetic devices, and there is a concern that other payers could have followed suit if this proposal had been finalized. Representative Erik Paulsen also sent a letter with Representative Anna Eshoo to CMS expressing concerns about the restrictions.
The full text of the senators’ letter from September is below:
Dear Acting Administrator Slavitt:
As co-chairs of the Senate Medical Technology Caucus, we are writing to express serious concern with the recently proposed Durable Medical Equipment Medicare Administrative Contractor Proposed/Draft Local Coverage Determination for Lower Limb Prostheses. If finalized this proposal would restrict access to modern prosthetic care for approximately 150,000 Medicare beneficiaries in need of lower limb prosthetics.
The coverage changes in the Proposed/Draft Local Coverage Determination would place limits on an amputee’s access to appropriate prosthetic devices. We are concerned these restrictions would significantly diminish the quality of life for seniors who have sustained limb loss.
Recognizing the problem, nine leading U.S. prosthetic researchers sent a letter to the Department of Health and Human Services expressing extreme concern that the proposal is not based on the science of prosthetic care. Any changes to Medicare coverage should be based on the strongest evidence available, and should consider both costs and the importance of preserving access to the devices that best meet the individual needs of amputees.
Healthcare providers across the nation look to Medicare reimbursement rates when developing their own policies. Therefore, we are concerned that other payers could follow suit if this proposal is finalized, disrupting access to modern care for nearly two million amputees across the country.
We urge you to immediately reconsider the Proposed/Draft Local Coverage Determination for Lower Limb Prostheses and we look forward to working with you on this issue.