Monday, October 19, 2015

On Prosthetic Care: White House Response Unacceptable

For many of us in the movement to halt proposed changes to the Local Cost Determination (LCD) for Durable Medical Equipment (DME) in Medicare benefits, the recent response by the Obama White House staff to our petition to review them was tepid, at best. At worst, one could say it was negligently apathetic. I am going to post both the petition request wording then the response from the "We the People" staff.

Rescind the Medicare proposal restricting access to prosthetic limbs and returning amputees to 1970’s standards of care.
Medicare, through its contractors, has proposed new coverage, coding, and clinical care guidelines that would have a profoundly negative impact on amputees across the United States.
If implemented, the policy installs new barriers that would limit and potentially deny access to appropriate prosthetic care. It eliminates coverage for certain prosthetic devices that amputees depend on for every step they take every day. It even would preclude amputees from using a prosthesis if they failed to meet the entirely nebulous and subjective standard of "the appearance of natural gait" while using the prosthesis.
Equally troublesome, the proposed policy contains no references to clinical or medical evidence supporting the changes.
For all of these reasons, the draft policy should be rescinded.
The petition has 110,136 signatures to date so far, well above the 100k threshold that the White House has set as a goal before they will take notice of any petition. However, I believe that the staff has not read, or understood for that matter, any of the proposed changes. One of the major issues is that the CMS (The agency that is responsible for implementing Medicare payouts) is the entity that is proposing the changes. Which makes the White House's response all the more ludicrous. This is a copy of what I received by E-Mail  Friday afternoon:

A response to your petition on a Medicare local coverage determination:
Thanks for using We the People, and for sharing your concerns about the local coverage determination for lower limb prostheses proposed by Medicare contractors. In order to get the most up-to-date information concerning your petition, we've gone to the Department of Health and Human Services (HHS) -- specifically, the Centers for Medicare and Medicaid Services (CMS), and the Administration for Community Living (ACL).
You can learn more about LCDs and how they're determined here.
The coverage determination process is still ongoing, but CMS wants to make clear that they’re committed to providing high quality care to all Medicare beneficiaries. They also wanted to make sure you know that HHS has met with stakeholders on this important issue, and both CMS and its contractors understand the questions that have been raised about access to the right prosthetic care -- including related technologies -- for Medicare beneficiaries.
We will be in touch with another update.--The We the People Team
Why am I all wound tight about this issue, anyway? I am not on Medicare and I will not qualify for it for almost 15 years. I am taking up this fight because EVERY insurance company in America uses Medicare guidelines as a baseline for the services that they provide. Any changes to that baseline means a probable loss in benefits per dollar of expenditure. The bottom line is that our bottom line (Each and every single person in America) will have to spend more out of pocket money for the basic care that we need to have to live a normalized life. If you give an agency free reign as the tepid response from the White House seems to have done, you open the doors for abuse. Tell me, Obama Administration, how can you go to CMS and bring our petition to their door, yet allow them to continue on their path to our ruination? Their purpose and proposal  is clear and we asked for your intervention. You simply turned to them and asked and they said "Oh, yeah, we know about what they want, we will give them what we think is high quality care" and you accepted that as an answer! NOTHING has changed!
I may be wrong, perhaps CMS will have listened to the 130 individuals that testified in the one open hearing in Washington DC, and perhaps they will make changes. I would like an assurance from the White House that if they do not make changes to their proposed wording, that the White House is committed to standing up and doing what is right. Can we get that from you?

Because Prosthetics are NOT A LUXURY!

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