The four Durable Medical Equipment Medicare Administrative Contractors (DME MACs) held a public meeting on Wednesday, August 26, in Linthicum, Maryland, to address the local coverage determination (LCD) draft policy for lower-limb prostheses. Hundreds of people attended, and many others listened and/or participated via teleconference. The meeting drew O&P professionals, prosthetic users, family members, physical therapists, physicians, podiatrists, and more, who spoke out against the draft policy.
David McGill, JD, vice president, legal affairs and reimbursement for Össur Americas, Foothill Ranch, California, and president of the National Association for the Advancement of Orthotics and Prosthetics (NAAOP), was one of more than 80 speakers on this issue. He chose to speak not in an official capacity, but as a prosthesis user. “Why should…a 45-year-old guy who is insured by Aetna care about Medicare policy, because it’s just Medicare policy, right? I want to be crystal clear about the fact that this isn’t just about Medicare policy. If you look at private insurance company lower-limb prosthetics medical policies, they often quote in full or substantively import…the coverage guidelines that are spoken about and listed in the current LCD. When the LCD gets updated, private payers update their policies accordingly. Medicare leads, the private insurance companies follow. What we are talking about today is not amputees in the Medicare program. We are talking about potentially every amputee in the United States,” he said.
The meeting was followed by a rally of individuals with amputations and others who traveled by bus to Washington, DC, to demonstrate in front of the U.S. Department of Health & Human Services building.
Following today’s public hearing and rally, officials from the Centers for Medicare & Medicaid (CMS) services held a meeting with stakeholders. A comment on the National Association for the Advancement of Orthotics and Prosthetics (NAAOP) page on Facebook noted that stakeholders report that Medicare officials were highly engaged, asked excellent questions, and are clearly interested in exploring these issues further. Another post stated that the U.S. Department of Veterans Affairs has confirmed that it will be submitting comments to CMS recommending that the proposed LCD on lower-limb prostheses be rescinded; an official announcement is forthcoming.