About The Bill
Why This Legislation Is Needed
Lymphedema is a medical condition that results in swelling of any part of the body when the lymphatic vessels and/or lymph nodes are damaged or inadequate. Lymphedema affects an estimated 1.5 to 3 million Medicare beneficiaries who currently receive sub-standard treatment from Medicare according to the current medical standard of care.
Untreated, or under-treated, lymphedema is progressive and leads to infection, disfigurement, disability and in some cases even death. Thus prognosis for the patient is far worse and treatment more costly when the disease is not identified and treated in the earlier stages.
Medicare does not currently cover the compression garments and bandages used daily in lymphedema treatment. 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 their everyday self-care.
States have already recognized that coverage for successful early treatment is essential and cost saving, and are beginning to require that private and state plans provide this coverage. A lymphedema treatment mandate went in to effect in North Carolina on January 1, 2010, one has been in effect in Virginia since 2004, and several other states have similar legislation pending.
What This Legislation Would Do
The Lymphedema Diagnosis and Treatment Cost Saving Act of 2011, HR 2499, will improve coverage for the diagnosis and treatment of lymphedema. This is a preventative treatment bill that will reduce health care costs while improving patient care and quality of life.
Medicare alone is spending billions of dollars every year treating largely preventable lymphedema-related cellulitis infections and other complications. Although this bill relates specifically to a change in Medicare law, it would almost certainly result in all private insurance policies following suit, thus improving the quality of care for all 5 millions Americans with lymphedema.
Specific goals of the bill are:
- Comprehensive treatment coverage, according to current medical treatment standards, for individuals with and at risk for lymphedema;
- The ability to add new treatment modalities to coverage as they become available and are approved;
- Preoperative measurements for cancer patients to aid in early detection and diagnosis;
- To provide for lymphedema patient education in the procedures for self-treatment so as to transfer the treatment from the clinical to the home setting;
- To enable patient self-treatment plan adherence by providing necessary medical supplies for use at home, as prescribed for each patient (compression garments, compression bandages, other compression devices, pneumatic compression pumps, etc);
- Reduction in total healthcare costs through avoidance of periodic infections, pain and disabilities resulting from this medical condition.
To read the bill in it’s entirety please click here.
To download an information packet about lymphedema and this bill click here.
This packet is perfect to share with members of Congress or anyone who wishes to better understand lymphedema, it’s treatment, why this legislation is needed and what HR 2499 will accomplish if passed.
