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David McGill Blogger

White House Announces CMS Striking Down Draft LCD!

Posted by David McGill | November 02, 2015

Today the White House issued its final response to the NAAOP "We the People" petition requesting that the White House rescind the draft LCD for lower limb prosthetics. Here's what you need to know:

  • The White House announced that the DME MACs "will not finalize the draft Lower Limb Prostheses Local Coverage Determination at this time."
  • Simultaneously, Medicare issued a press release stating the same thing.
  • The Medicare press release additionally noted that Medicare will convene a "multidisciplinary Lower Limb Prostheses Interagency Workgroup in 2016. The purpose of the Workgroup is to develop a consensus statement that informs Medicare policy by reviewing the available clinical evidence that defines best practices in the care of beneficiaries who require lower limb prostheses."
  • The aforementioned Workgroup will be comprised of clinicians, researchers, policy specialists, and patient advocates from different federal agencies. 
  • The Workgroup has the authority to make recommendations concerning study designs and outcome measures "that best inform patient oriented function, quality of life and service satisfaction in this realm."
  • Medicare says there will be the opportunity for public comment on the Workgroup consensus statement and any related activities.

 

What does this mean for you?

There are two things we want to highlight coming out of this decision.

First, Medicare's refusal to finalize the draft LCD is a significant win for both patients and the O&P profession. The proposal had significant deficiencies that would have denied amputees access to certain types of prosthetic components, forced them to wait longer for those components they did qualify for, and increased their out-of-pocket costs. Medicare's implicit recognition of these facts is a welcome outcome, and both it and the White House deserve credit for their respective responses. With the Workgroup not initiating meetings until 2016, we can reasonably expect that this decision will forestall any significant changes to the Local Coverage Determination until late next year at the earliest (given the scope of the Workgroup's charter), but more likely 2017. 

Second, while you can and should celebrate this decision, recognize that Medicare is not letting go of the issue. Rather, it is simply taking another route towards redrafting the current LCD via the interagency Workgroup. Of particular concern is the fact that the CMS press release suggests that the Workgroup will be comprised only of individuals from different federal agencies, and not from a broader group of outside stakeholders with an interest in this issue. Similarly, even though Medicare promises the opportunity for public comment when the Workgroup releases its consensus statement, it is unclear whether the DME MACs will then be able to implement changes to the current LCD without any formal notice and comment period, as happened with the now-defunct draft LCD. In short, as with any issue of this complexity, there is ambiguity that still needs to be clarified.

Össur R&R will continue to closely monitor events as they develop and provide you updates as new information becomes available. But lastly, we want to thank the more than 100,000 patients, health care providers, and other interested individuals who signed the NAAOP petition, as well as the many organizations who worked tirelessly since mid-July to achieve this outcome. Compared to the potential alternatives, this is a positive short-term outcome.​

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