I 
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) intro-
duced 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 pro-
posed Medicare local coverage determination on lower 
limb prostheses. 
Be it enacted by the Senate and House of Representa-
tives 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: 
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(1) The Medicare program includes coverage for 
prosthetic limbs under section 1861(s)(9) of the So-
cial Security Act (42 U.S.C. 1395w(s)(9)). 
(2) As a result of significant Federal and pri-
vate investment in research and development over 
the past decades, beneficiaries with lower limb pros-
theses 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 Serv-
ices, through Medicare contractors known as Dura-
ble 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. 
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(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 con-
tractors’ 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 in-
surers. 
(9) Given the far reaching effect of these poli-
cies, and the fact that little or no clinical or sci-
entific evidence supported the issuance of these pro-
posals, any changes to prosthetic limb coverage 
should be made only after a transparent process in 
which evidence is offered to justify coverage modi-
fications, meaningful stakeholder feedback is solic-
ited, and the Secretary and Medicare contractors re-
ceive and respond to this stakeholder feedback in a 
public manner. 
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(10) A moratorium on the implementation and 
enforcement of these proposed policies would enable 
the Secretary and the Medicare contractors to en-
gage in such a transparent process. 
SEC. 2. MORATORIUM ON IMPLEMENTATION OF PROPOSED 
MEDICARE LOCAL COVERAGE DETERMINA-
TION 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 poli-
cies 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 
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DETERMINATIONS.—Section 1862(l)(5) of the Social Se-
curity Act (42 U.S.C. 395y(l)(5)) is amended— 
(1) by redesignating subparagraph (C) as sub-
paragraph (D); and 
(2) by inserting after subparagraph (B) the fol-
lowing new subparagraph: 
‘‘(C) SECRETARY OVERSIGHT AND GUID-
ANCE
IN
DEVELOPING
LOCAL
COVERAGE
DE-
TERMINATIONS.—The Secretary shall provide 
guidance and oversight of any local coverage de-
termination developed by a medicare adminis-
trative contractor to ensure that the local cov-
erage 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 pros-
theses as proposed by a medicare administrative con-
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