Marsha Blackburn, Tammy Duckworth, G.K. Butterfield, Brett Guthrie ask GAO to Evaluate Barriers For Assistive Technologies

Washington, D.C. – U.S. Senators Marsha Blackburn (R-Tenn.) and Tammy Duckworth (D-Ill.), along with U.S. Representatives G. K. Butterfield (D-N.C.) and Brett Guthrie (R-Ky.) sent a bipartisan and bicameral letter to the Government Accountability Office (GAO) requesting an evaluation of appropriate coverage of assistive technologies provided to patients who experience amputation or live with limb differences.

“On behalf of the 2.1 million Americans living with limb loss and limb difference and the 28 million more at risk of limb loss, we thank Senators Duckworth and Blackburn and Representatives Butterfield and Guthrie for their continued efforts to improve the lives of those impacted by limb loss and limb difference. When only 35 percent of Americans living with limb loss or limb difference receive a prosthetic device, it is incumbent upon us to discover where the barriers to access exist and then remove those barriers to allow Americans to gain the necessary access. This effort displays a commitment in a bipartisan manner from Congressional leaders to fully develop an understanding of the needs impacting the limb loss and limb difference community,” said the Amputee Coalition.

High-Quality Assistive Technologies Are Critical For Amputees Or Patients 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,” wrote the senators and representatives.

Health Care Payers Will Benefit From The GAO’s Research

“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.”

GAO’s Evaluation Of The Barriers To Accessing Prosthetic Devices Will Help Inform Future Legislation

“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 1st, 2023, a report regarding the barriers to access to prosthetic devices. This will be used to inform future legislation,” the members continued.

Read the full letter here or below.

 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 1st, 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: 
   1. timely access to care, including educating patients;
   2. the availability of assessments and guidelines for assistive device determinations;
   3. individual beneficiary accommodations in both public and private health plans;
   4. affordability of assistive devices, including both public and private payers;
   5. the availability of rehabilitation services offered to support acclimation to assistive devices offered by both public and private health plans; and
   6. information regarding the timeline by which health care providers follow to make surgical assessments for patients and to assess patients for assistive devices.

1. 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:

1. 1. the percentage of patients who have access to assistive technologies; 
   2. performance measures that monitor the timeliness of processing prosthetic prescriptions;
   3. coverage denials and overturn rates; 
   4. coding for physician or physical therapy or occupational therapy assessments, including whether a prosthetist was included in the assessment process;
   5. the rate of patients returning to the workforce and specifically after receiving a prosthetic device comparable to other assistive technologies;
   6. reductions in long-term assistive technologies and support services; 
   7. 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
   8. the amount expended by individual entities on prosthetics relative to total amount expended by such entities.