Washington, D.C.– In a bipartisan letter to the agencies that oversee Medicare, Congressman Erik Paulsen (MN-03) expressed strong concern that a proposed rule regarding lower limb prosthetics would restrict access to quality prosthetic care and result in worse health outcomes for patients. In the letter, sent to both the Department of Health and Human Services and Centers (HHS) for Medicare and Medicaid Services (CMS), Paulsen asks that CMS protect flexibility for patients and doctors to determine the best prosthetic for an individual. Last month, a number of prosthetic users and patient groups from Minnesota traveled to Washington, D.C. to protest the proposed rule outside of HHS headquarters. Joining Paulsen in sending the letter was fellow co-chair of the House Medical Technology Caucus, Rep. Anna Eshoo (CA-18).

The letter, which is available here, states:

“The loss of any limb is a traumatic and life-altering experience. Yet, thanks to medical innovation, modern prostheses can help amputees live a healthy, active life.  For seniors who sustain limb loss, prostheses can help regain significant amounts of functionality and eliminate the need to be confined to a wheelchair. For the millions of amputees under age 65, modern prosthetic care allows them to return to work and maintain the ability to live independently.”

The letter goes on to say:

“As Co-Chairs of the House Medical Technology Caucus, we fear these policies will suppress medical innovation and limit patient access to life-improving technology. Instead of a one-size-fits-all approach, CMS should allow medical professionals and patients to work together to determine a patient’s functional ability and identify the best prosthetic device for an individual.”

Congressman Paulsen also spoke on the House floor about the need for CMS to chart a different path on their prosthetic policy. Video is available here.

Background:

·         In July, a Medicare contractor released a proposed draft Local Coverage Determination (LCD) for lower limb prosthetics. Under the LCD, coverage for lower limb prosthetics in the geographic area covered by the contractor would change dramatically.

·         Most of the proposed changes involve the Uniform Code Set, which applies to all payers. This means that once finalized, the LCD is likely to be adopted for the rest of the Medicare system and then apply to veterans receiving care at the VA and patients on private insurance.

·         The proposal eliminates or restricts coverage of multiple prosthetics that have undergone years of development, coding assignment, and widespread use by Medicare beneficiaries. This will cause patients to live with prosthetic technology that is outdated and not consistent with the current standard of care.

·         Under the new policy, Medicare would no longer consider “potential functional abilities” when determining a patient’s need for a particular device. Instead, CMS would rely on patients’ “documented performance using their immediately previous prosthesis.” This coverage change will result in patients getting a device that does not truly meet their medical needs or long-term potential.

·         Eliminates access to certain prosthetic components if the amputee uses a cane, crutch, or walker, or cannot achieve “the appearance of a natural gait” while using the prosthesis.

·         Eliminates the licensed prosthetist in determining an amputee’s functional capabilities and devising a care plan. Instead, the LCD creates a new system where multiple physicians and other medical professionals will be required to conduct functional assessments and include additional documentation.

Congressman Paulsen, a champion of small business and advocate of free enterprise, entrepreneurship, and innovation, serves on the House Ways and Means Committee, the bicameral Joint Economic Committee, and is co-chair of the Congressional Medical Technology Caucus.

For more information on Congressman Paulsen’s work in Congress visit paulsen.house.gov. 

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