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. This is explained in more detail in a written exchange between our bill sponsor, Congressman Reichert, and former Health and Human Services Secretary, Kathleen Sebelius. Click here to read their correspondence.
- 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. (See section above for details.) 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 decisions made after the legislation is passed. This allows flexibility to adjust policy as needed in the future, without having to pass new legislation.
Additional Information about the Lymphedema Treatment Act
Our current bill sponsors are: Representative Dave Reichert, WA-8 (lead sponsor); Representative Leonard Lance, NJ-7 (co-lead); Representative Earl Blumenauer, OR-3 (co-lead); and Representative Bruce Braley, IA-1 (co-lead). To read press releases from these offices about their introduction of the bill click here.
A complete list of current cosponsors can be seen here.
A PDF of the actual bill can be viewed and downloaded here.
A “scoring” report for the Lymphedema Treatment Act can be read here. A “score” estimates the federal costs that would be incurred by implementing a piece of legislation. A document explaining this report, as well as related FAQ’s, is available here.
Resources for Sharing Information about the Lymphedema Treatment Act
To download an information packet appropriate for sharing ONLY with members of Congress and their staff, click here. (Please ensure that you thoroughly read and understand this document yourself before sharing it with congressional offices. If you have any questions, don’t hesitate to Contact Us. Remember that our Advocacy Handbook is full of helpful tips, such as talking points and FAQ’s. )