Letter to Gene Dodaro, Comptroller General - Blackburn, Duckworth, Butterfield, Guthrie Ask GAO To Evaluate Barriers For Assistive Technologies

Letter

Mr. Dodaro:

We write today to request the Government Accountability Office (GAO) evaluate appropriate coverage of assistive technologies provided to patients who experience amputation or live with limb differences.

The need for high-quality assistive technologies and quality health care is vitally important. In the United States, it is estimated that 185,000 amputations occur each year. This figure is expected to double by 2050, due to increasing rates of contributing conditions, including vascular disease, trauma and cancer. Further, two million Americans currently live with limb loss or limb difference. Two-thirds of these Americans will not receive a prosthetic device, and there is a lack of information to explain why such a disparity exists.

In addition, healthcare payers, such as the Centers of Medicare and Medicaid Services, the Veterans Health Administration and private insurers will benefit from the additional research into limb loss and limb difference that this bill would provide.

In order to understand the gaps and disparities in access to these critical health care services for impacted or at-risk individuals, we request that GAO evaluate and submit to Congress, no later than July 1, 2023, a report regarding the barriers to access to prosthetic devices. This will be used to inform future legislation. The report should address, at minimum the following questions:

1. What barriers exist to using assistive technologies (including prosthetic devices) in health care coverage of patients with limb loss and limb difference? Please specifically consider the following factors to appropriately answer this question:

a. timely access to care, including educating patients;

b. the availability of assessments and guidelines for assistive device determinations;

c. individual beneficiary accommodations in both public and private health plans;

d. affordability of assistive devices, including both public and private payers;

e. the availability of rehabilitation services offered to support acclimation to assistive devices offered by both public and private health plans; and

f. information regarding the timeline by which health care providers follow to make surgical assessments for patients and to assess patients for assistive devices.

2. To what extent are patient outcomes using assistive technologies affected by being on Medicare or private insurance or when care is provided by the Department of Veterans Affairs? Please specifically consider the following factors to appropriately answer this question:

a. the percentage of patients who have access to assistive technologies;

b. performance measures that monitor the timeliness of processing prosthetic prescriptions;

c. coverage denials and overturn rates;

d. coding for physician or physical therapy or occupational therapy assessments, including whether a prosthetist was included in the assessment process;

e. the rate of patients returning to the workforce and specifically after receiving a prosthetic device comparable to other assistive technologies;

f. reductions in long-term assistive technologies and support services;

g. for those using assistive technologies, payer sponsored programs to reduce falls and secondary complications for patients also living with diabetes, heart disease, vascular disease and other conditions that increase the risk of limb loss; and

h. the amount expended by individual entities on prosthetics relative to total amount expended by such entities.

If you have any questions with regards to this report, please contact our staff at
Christopher_Kelly@Blackburn.Senate.gov; Alisa_Winchester@duckworth.senate.gov;
Caitlin.VanSant@mail.house.gov; and Brian.Fahey@mail.house.gov. Thank you for your
prompt attention to this issue.

Sincerely,

Source