About The Bill
Why This Legislation Is Needed
Lymphedema is a non-curable but treatable medical condition that results in an accumulation of lymph fluid swelling in parts of the body where lymphatic vessels and/or lymph nodes are damaged, nonfunctional or inadequate. Lymphedema affects an estimated 5-6 million Americans, with the majority of cases caused by cancer treatment.
Untreated, or under-treated, lymphedema is progressive and leads to increased morbidity. Thus prognosis for the patient is far worse and treatment more costly when the disease is not identified and treated in the earlier stages. Complete Decongestive Therapy (CDT) is the gold standard and only known course of treatment for lymphedema. CDT is a multi-modal treatment that is only effective when used in its entirety.
Currently, Medicare, and consequently many other policies, cover all but the most critical component, the medically necessary compression supplies used daily in lymphedema treatment, citing they do not fit under any existing benefit category. 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 successful early 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.
What This Legislation Would Do
The Lymphedema Diagnosis and Treatment Cost Saving Act will improve coverage for the treatment of lymphedema, thereby reducing health care costs while improving patient care and quality of life for
millions of Americans with lymphedema.
Specific goals of the Act are as follows:
- provide comprehensive lymphedema treatment coverage, according to current
medical treatment standards;
- 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);
- allow for new treatment modalities to be considered for coverage as they
become available and are approved;
- reduce the total healthcare costs associated with this disease by decreasing the incidence of
complications, co-morbidities 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 the Lymphedema Treatment Act will accomplish if passed.