November 2015

CMS stays prosthetic coverage draft; AOPA calls the decision a ‘partial win’

The White House announced on November 2 that the Centers for Medicare & Medicaid Services (CMS) will not finalize a controversial draft policy concerning coverage determinations for lower limb prostheses.

The American Orthotic & Prosthetic Association (AOPA) in a press release the same day termed the response a “partial win,” noting the draft policy hadn’t been rescinded and citing concerns about public stakeholders’ absence from the CMS-proposed workgroup that in 2016 will develop an evidence-based consensus statement on best practices in lower limb prosthetic care.

The multidisciplinary Lower Limb Prostheses Interagency Workgroup will be composed of “clinicians, researchers, and policy specialists from different federal agencies,” according to the announcement on the We the People website.

“We recognize and believe it is a positive step that the draft LCD [Local Coverage Determination] will not be implemented at this time. However, we continue to believe that the draft LCD should be rescinded by the Medicare Contractors and that CMS should provide patient and provider stakeholders with a meaningful role in the devel­opment of future coverage policies for lower limb prostheses,” AOPA said in its press release.

The amputee community and O&P organizations have led a vocal battle against the lower limb prostheses LCD since it was proposed on July 16, reporting that current scientific evidence didn’t support the proposed changes, which they said threatened to return amputees to 1970s care.

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