House committee launches inquiry into prosthetic changes

Wednesday, May 4, 2016

WASHINGTON – The House Committee on Oversight and Government Reform has launched an inquiry into the draft local coverage determination for prosthetics.

In a letter to Department of Health and Human Services Secretary Sylvia Burwell, the committee says the LCD, released in July, relies on outdated data to limit access to clinically appropriate and medical necessary prosthetic care for Medicare beneficiaries.

“We are concerned that this draft LCD would deny access to advanced and higher quality prosthetics that improve mobility, function and independence of those beneficiaries,” the committee states.

To help it understand the draft LCD, the committee requests, among other things, documents to determine CMS’s justification and process for deferring to LCDs, rather than the national coverage determination.

Last week, Rep. Renee Ellmers, R-N.C., introduced a bill that would halt the changes to coverage for prosthetics. The “Preserving Access to Modern Prosthetic Limbs Act of 2016” would restrict CMS from implementing the draft LCD until at least June 30, 2017.

The bill would also require the agency and its contractors to remove the draft LCD from their websites. Private payers like United Healthcare and Cigna have made coverage changes since it was made public in July.