About The Bill
For the most current information about the bill, scroll to the bottom of this page.
Why This Legislation Is Needed
Currently, Medicare, and consequently many other policies, do not cover one of the critical components of lymphedema treatment, the medically necessary compression supplies used daily in lymphedema treatment. As a result, many patients suffer from recurrent infections, progressive degradation in their condition and eventual disability because they cannot afford the compression supplies required to maintain their condition.
Although this legislation relates specifically to a change in Medicare law, it would set a precedent for Medicaid and private insurers to follow. States have already recognized that coverage for comprehensive treatment is essential and cost saving, and are beginning to require that private and state plans provide this coverage. Lymphedema treatment mandates have been in effect in North Carolina since 2010 and in Virginia since 2004, and several other states have similar legislation pending.
Medicare’s failure to cover compression treatment supplies stems from the fact that these items cannot be classified under any existing benefit category in Medicare statute (law). The Center for Medicare Services (CMS) does not have the authority to add or redefine benefit categories, only Congress does, hence the need for this legislation. The following is an exchange between our bill sponsor, Congressman Reichert, and Health and Human Services Secretary, Kathleen Sebelius, prior to Congressman Reichert’s decision to sponsor the
Lymphedema Treatment Act:
Congressman Dave Reichert’s question to HHS Secretary Sebelius: Lymphedema affects an estimated 1.5 to 3 million Medicare beneficiaries. Individuals often need constant care to avoid recurrent infections. While Medicare does cover and pay for statutorily limited therapy and sequential compression pumps, many patients suffer from recurrent infections, progressive degradation in their condition and eventual disability because they cannot afford the compression bandages and garments required for everyday self-care. I have heard from patients and providers that state compression garments are a necessary form of treatment for patients with Lymphedema. They state compression garments help to improve the quality of life and stave off reoccurring infections for patients. Why does CMS not cover these treatments? Does CMS need a statutory change in order to provide coverage for these garments?
Specific goals of the Act are as follows:
- to provide comprehensive lymphedema treatment coverage, according to current
medical treatment standards;
- to enable patient self-treatment plan adherence by providing necessary medical supplies
for use at home, as prescribed for each patient (including gradient compression
garments, bandages, and other compression devices);
- to reduce the total healthcare costs associated with this disease by decreasing the incidence of
complications, co-morbidities and disabilities resulting from this medical condition.
The HHS Secretary has confirmed that a change in statute is necessary to allow for coverage of compression supplies. The Lymphedema Treatment Act will amend Sec. 1861 [42 U.S.C. 1395x] of the Social Security Act
to enable coverage of these items under Durable Medical Equipment.
Details surrounding coverage, such as allowable quantities, etc., are not something that is written into statute. Matters of this nature are determined by policy written after the legislation is passed. This allows flexibility to adjust policy as needed in the future, without having to pass new legislation.
Original Sponsors of This Bill in the Current Congress
Representative Dave Reichert (WA-8)
Representative Leonard Lance (NJ-7)
Representative Earl Blumenauer (OR-3)
Representative Bruce Braley (IA-1)
To read press releases from the above offices click here.
A complete list of current cosponsors can be seen here.
A PDF of the actual bill can be viewed and downloaded here.
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