CMS holds off on coverage changes for prostheses

Tuesday, November 3, 2015

WASHINGTON – CMS has taken a step back from its controversial plans to change the coverage requirements for lower limb prostheses.

The agency’s DME MACs released a draft local coverage determination in July, setting off a chain of events that included a public hearing, a protest, high-stakes meetings and a “We the People” petition.

“Both CMS and its contractors have heard your concerns about access to prostheses for Medicare beneficiaries,” the agency stated in an announcement this week. “The DME MACs will not finalize the draft local coverage determination at this time.”

Among the proposed changes in the LCD: requiring the patient to complete a face-to-face visit and undergo a rehab program before he can obtain a prosthetic device.

Instead of finalizing the LCD, CMS is convening a multidisciplinary work group to develop a consensus statement based on a review of the available clinical evidence that defines best practices in the care of beneficiaries who require lower limb prostheses. The consensus statement will inform future policy.

“The workgroup may also identify areas where evidence gaps exist related to the prescription of lower extremity prostheses and make recommendations concerning the study designs and outcome measures that best inform patient-oriented function, quality of life and service satisfaction in this realm,” the announcement reads.

The workgroup will be comprised of clinicians, researchers, policy specialists and patient advocates from different federal agencies.

CMS says it will ensure there is opportunity for public comment and engagement on the consensus statement and any related activities.