One year ago today, I sat glued to my computer, watching the live stream of that day’s Congressional proceedings. Nearly 13 years after the Lymphedema Treatment Act was first introduced, the bill was finally being voted on by the full Congress.
Words cannot express the joy and relief I felt when the bill was passed. For nearly all of my son’s 16 years of life, I had been working to end this injustice and close the coverage gap for the compression garments he began wearing when he was just seven months old.
And now, we are just days away from the start of Medicare coverage for these vital medical supplies! Hopefully, other insurance plans will quickly follow suit, and our group will be working to make sure they do.
We will also be producing and distributing new educational materials to make sure that patients and providers are aware of and obtaining the new coverage, as well as constructing a brand-new website to better serve the lymphedema community as we tackle new goals.
But our ability to do all of this and more depends on your support.
So today, I’m humbly asking you to please make a donation if you have not yet done so during this holiday giving season. We would be so grateful for a contribution of $50 or whatever is right for your budget. You can make a donation online or by mailing a check.
We’ve accomplished so much together, but there is more to do. Thank you for your support and happy holidays!
Heather Ferguson
Founder & Executive Director
Lymphedema Advocacy Group
LymphedemaTreatmentAct.org
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Pictures Taken at our DC Celebration in May
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Below is a summary of the LTA final rule. You can read the full 65 pages here. We have also inserted notes into our group’s public comment document, which can be read here, to indicate which of our comments were incorporated into the final rule.
The final rule is a huge victory for patients, but our work is not done yet. Please visit our Take Action page if you have any insurance plan other than traditional Medicare and haven’t contacted your own insurance provider yet.
Lymphedema Treatment Act Final Rule Coverage Summary
What will be covered:
- Custom and standard fit daytime and nighttime garments.
- Custom and standard fit gradient compression wraps with adjustable straps.
- Bandaging supplies for any phase of treatment.
- Accessories including but not limited to donning and doffing aids, padding, fillers, linings, and zippers.
Frequency allowances:
- Daytime garments – 3 sets (one garment for each affected body part) every six months, standard or custom fit, or a combination of both
- Nighttime garments – 2 sets (one garment for each affected body part) every two years, standard or custom fit, or a combination of both
- Bandaging supplies – no set limit in the rule.
- Accessories – no set limit, will be determined on a case-by-case basis depending on the needs of the patient.
Coverage requirements:
- To be eligible for the above coverage, a patient must have been diagnosed with lymphedema and have a prescription for the compression supplies.
- The coverage will begin January 1, 2024. There will be no retroactive coverage, meaning, you cannot submit claims for any garments or supplies purchased or ordered before 1/1/2024.
Codes and reimbursement rates:
- Starting next year, there will be 81 HCPSC codes specifically for lymphedema compression supplies, most of which are new, and the rule also outlines the process for the creation of additional codes in the future if needed.
- The corresponding reimbursement rates for these codes will be released soon and are not included in the rule.
Deductibles and copay:
- For traditional Medicare — these supplies will be covered under Part B, so the annual Part B deductible and 20% coinsurance apply to all compression supplies.
- For Medicare Advantage and all other types of insurance — out-of-pocket costs will vary depending on the specific terms of your plan. It is likely that your compression supplies will be subject to the same copay and deductibles as supplies covered under the DMEPOS (Durable Medical Equipment, Prosthetic and Orthotic Supplies) section of your policy.
PLEASE NOTE: The final rule also outlines the process for making future changes to and/or additions to coverage if/when needed. This is very important, and ensures we will not be in the position of needing to get another law passed if adjustments to the coverage need to be made, or if new treatment supplies become available and need to be added to coverage.
Together, our advocacy made all of this possible!
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