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Independent Living News & Policy from the National Council on Independent Living

Action Alert: Prevent Drastic Cuts for Prosthetic Coverage!

Medicare has proposed a revision to their current lower limb prosthesis policy that will severely restrict access and coverage. This proposed policy (PDF) will create a new, much lower standard for prosthetic care, and we need to make sure it does not move forward.

There are many problems with the proposed policy. Some of these problems lie in the discriminatory functional assessments that have been proposed. According to the policy, assessments of an individual’s functional success will be negatively impacted if the individual uses a mobility device, or if the prosthesis does not provide the appearance of a natural gait. An individual’s failure to walk unassisted or with a ‘natural gait’ can limit access to higher quality and clinically appropriate prosthetics. Both of these requirements are discriminatory and do not reflect reality for many amputees.

Additionally, new amputees will be required to meet extensive criteria before being determined eligible for their initial prosthesis. Among other requirements, individuals must undergo excessive evaluations (including neuromuscular, cardio-pulmonary capacity, and cognitive evaluations), which will result in major delays in the delivery of much needed devices. Beyond that, new amputees’ individual needs and capabilities are completely discounted, and all new amputees are restricted to a basic “preparatory” prosthesis. Once they are eligible for a new prosthesis, only current functional abilities will be considered when determining prosthetic needs – potential functional abilities will no longer be considered.

This proposed policy’s restrictions are broad and far-reaching. Individuals who have certain health conditions can be denied access to higher quality prosthetics. Limitations have been placed on feet and ankles by combining them into a single code, and coverage has been limited for roll-on prosthetic liners. All of the new restrictions imposed by this policy are unacceptable.

Please take a moment to sign the petition seeking to rescind this proposal. If the petition reaches 100,000 signatures by August 30, the White House is obligated to respond! At the time of this alert, they are over three-quarters of the way there – let’s reach 100,000!

Once you’ve signed the petition, please send comments to the Centers for Medicare & Medicaid Services (CMS) and your representatives in Congress. The comments have been drafted, but please feel free to personalize them as you see fit. CMS and Congress need to hear that NCIL members around the country are extremely concerned with this proposed Medicare policy.

People who rely on Medicare should not have to face unnecessary hurdles to receive quality prosthetic limbs. The proposed changes to the current policy will limit choice, reduce quality, and restrict access. Please help us ensure that this harmful and discriminatory proposal is rescinded!

Comments

  1. Scott M Crawford says:

    My friends that use prothetic limbs NEED them like typical people NEED theirs! Making individuals jump through unnecessary hoops only to be denied is cruel and unthinkable. Who came up with this mean-spirited rule???

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