Center for Medicare Advocacy Files Civil Rights Complaint on Behalf of People Who Need Lower Limb Prostheses
On October 8, 2015 the Center for Medicare Advocacy filed a complaint with the Office of Civil Rights regarding Proposed Local Coverage Determination (LCD) DL 33787. This proposed LCD would unfairly and illegally restrict Medicare coverage for beneficiaries in need of lower limb prostheses. The complaint was filed on behalf of Dr. Roger Catlin, an above-knee amputee who wears an elevated vacuum socket, micro-processor knee and an energy storing foot, and the thousands of others in situations similar to his.
The proposed LCD would:
- Ignore consideration of a beneficiary’s potential to function;
- Eliminate all reasonable and necessary coverage for a good fitting prosthetic;
- Impose discriminatory requirements for upper body strength, adequate posture, cognitive capability, sufficient neuromuscular control, sufficient cardio-vascular capacity and more;
- Remove access to coverage unless a person demonstrates the “appearance of a natural gait,” or if a person needs crutches or a cane;
- End coverage for expert opinions by licensed and certified prosthetists;
- Require a person to undergo an aggressive and unreasonable rehabilitation program.
The proposed new criteria treats prostheses users like second class citizens, not entitled to proper fitting prosthetic limbs with components needed to achieve normal levels of function and independence.