Coats, Klobuchar Urge Centers for Medicare and Medicaid Services to Immediately Reconsider Restrictions on Payments for Prosthetics

WASHINGTON, DC – Senators Dan Coats (R-Ind.) and Amy Klobuchar (D-Minn.) are urging the Centers for Medicare and Medicaid Services (CMS) to immediately reconsider restrictions on payments for prosthetics. Recently proposed changes in Medicare coverage would restrict access to modern prosthetic care for approximately 150,000 Medicare beneficiaries in need of lower limb prosthetics. In a letter to CMS, 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.

“If finalized this proposal would restrict access to modern prosthetic care for approximately 150,000 Medicare beneficiaries in need of lower limb prosthetics,” the senators wrote. “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. We are concerned these restrictions would significantly diminish the quality of life for seniors who have sustained limb loss.” 

The proposed changes, which were announced in July, would require a medical exam by a doctor or health professional other than a prosthetics expert to determine functionality, as well as stronger restrictions for patients to qualify for high-tech devices. These coverage changes would place limits on an amputee’s access to appropriate prosthetic devices, and there is a concern that other payers could follow suit if this proposal is finalized. 

The full text of the letter 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.

 

Sincerely,

 

Senators Dan Coats and Amy Klobuchar