[Congressional Bills 114th Congress]
[From the U.S. Government Publishing Office]
[H.R. 5045 Introduced in House (IH)]

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114th CONGRESS
  2d Session
                                H. R. 5045

  To impose a moratorium on the implementation of a proposed Medicare 
         local coverage determination on lower limb prostheses.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                             April 25, 2016

    Mrs. Ellmers of North Carolina (for herself and Ms. Schakowsky) 
 introduced the following bill; which was referred to the Committee on 
    Ways and Means, and in addition to the Committee on Energy and 
Commerce, for a period to be subsequently determined by the Speaker, in 
   each case for consideration of such provisions as fall within the 
                jurisdiction of the committee concerned

_______________________________________________________________________

                                 A BILL


 
  To impose a moratorium on the implementation of a proposed Medicare 
         local coverage determination on lower limb prostheses.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE; FINDINGS.

    (a) Short Title.--This Act may be cited as the ``Preserving Access 
to Modern Prosthetic Limbs Act of 2016''.
    (b) Findings.--Congress finds the following:
            (1) The Medicare program includes coverage for prosthetic 
        limbs under section 1861(s)(9) of the Social Security Act (42 
        U.S.C. 1395w(s)(9)).
            (2) As a result of significant Federal and private 
        investment in research and development over the past decades, 
        beneficiaries with lower limb prostheses are able to maintain 
        optimal function and lead productive and independent lives.
            (3) Federal spending for prosthetic devices in the Medicare 
        program has decreased by 15 percent between 2010 and 2014.
            (4) The Secretary of Health and Human Services, through 
        Medicare contractors known as Durable Medical Equipment 
        Medicare Administrative Contractors, released on July 16, 2015, 
        a document entitled ``Local Coverage Determination (LCD): Lower 
        Limb Prostheses (DL33787)'', which applies to all Medicare 
        beneficiaries across the United States.
            (5) The policies proposed in this document would 
        comprehensively change the requirements under which a Medicare 
        beneficiary would qualify for a lower limb prosthetic device 
        and would seriously restrict access to modern prosthetic care.
            (6) If finalized, the changes proposed in this document 
        would create coverage requirements that are inconsistent with 
        current clinical practice and would arbitrarily and 
        unreasonably deny Medicare beneficiaries access to prosthetic 
        limb technologies considered the current standard of care.
            (7) Under these proposed policies, beneficiaries instead 
        would be eligible for prosthetic devices that are functionally 
        outdated, less durable, and less safe.
            (8) The adverse impact of the Medicare contractors' 
        proposed policies extend well beyond the Medicare program and 
        has implications for other Federal health programs, such as 
        health programs of the Veterans Administration, and commercial 
        insurers.
            (9) Given the far reaching effect of these policies, and 
        the fact that little or no clinical or scientific evidence 
        supported the issuance of these proposals, any changes to 
        prosthetic limb coverage should be made only after a 
        transparent process in which evidence is offered to justify 
        coverage modifications, meaningful stakeholder feedback is 
        solicited, and the Secretary and Medicare contractors receive 
        and respond to this stakeholder feedback in a public manner.
            (10) A moratorium on the implementation and enforcement of 
        these proposed policies would enable the Secretary and the 
        Medicare contractors to engage in such a transparent process.

SEC. 2. MORATORIUM ON IMPLEMENTATION OF PROPOSED MEDICARE LOCAL 
              COVERAGE DETERMINATION ON LOWER LIMB PROSTHESES.

    (a) Moratorium.--
            (1) In general.--The Secretary of Health and Human Services 
        and any Medicare Administrative Contractor may not implement 
        and enforce the policies in the LCD on lower limb prostheses 
        (as defined in subsection (d)(1)), in whole or in part, during 
        the period beginning on the date of the enactment of this Act, 
        and ending on June 30, 2017.
            (2) Removal of policy from websites.--The Secretary of 
        Health and Human Services and its medicare administrative 
        contractors shall remove the LCD on lower limb prostheses from 
        the websites of the Centers for Medicare & Medicaid Services 
        and its medicare administrative contractors during the period 
        of the moratorium under paragraph (1).
    (b) Providing the Secretary With Authority To Oversee the 
Development of Local Coverage Determinations.--Section 1862(l)(5) of 
the Social Security Act (42 U.S.C. 395y(l)(5)) is amended--
            (1) by redesignating subparagraph (C) as subparagraph (D); 
        and
            (2) by inserting after subparagraph (B) the following new 
        subparagraph:
                    ``(C) Secretary oversight and guidance in 
                developing local coverage determinations.--The 
                Secretary shall provide guidance and oversight of any 
                local coverage determination developed by a medicare 
                administrative contractor to ensure that the local 
                coverage determination is consistent with this 
                title.''.
    (c) Construction.--Nothing in this section shall be construed to 
prevent the Secretary from enforcing existing statutes, regulations, 
and local coverage determinations other than with respect to policies 
in the LCD on lower limb prostheses.
    (d) Definitions.--In this section:
            (1) LCD on lower limb prostheses.--The term ``LCD on lower 
        limb prostheses'' means the local coverage determination on 
        lower limb prostheses as proposed by a medicare administrative 
        contractor in the document (DL33787) released on July 16, 2015, 
        and any successor to such determination.
            (2) Medicare administrative contractor.--The term 
        ``medicare administrative contractor'' has the meaning given 
        such term in section 1874A(a)(3)(A) of the Social Security Act 
        (42 U.S.C. 1395kk-1(a)(3)(A)).
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