The Paths to Coverage for Compression Supplies

Prior to the introduction of the Lymphedema Treatment Act (LTA), patient advocates including myself and others attempted to obtain coverage for compression supplies by working with the Center for Medicare Services (CMS). CMS’s consistent response was that the supplies are not coverable due to the lack of a benefit category under which to place the items, and more specifically, that the Durable Medical Equipment (DME) benefit category has a three year longevity requirement, which compression supplies do not meet. Because CMS does not have the authority to add or redefine benefit categories, only Congress does, we started down the legislative path.

Since assuming sponsorship of the LTA, Congressman Reichert has asked every subsequent Health and Human Services (HHS) Secretary if he or she could implement coverage without a legislative fix. Each has maintained that CMS could not. With the confirmation of Secretary Azar, Congressman Reichert asked yet again if a regulatory fix was possible. While there has been no official change of position on this issue, Secretary Azar and CMS authorities have expressed a new openness to discussing the matter.

Congressman Reichert will be retiring at the end of this term (December of 2018), and is 100% committed to accomplishing the goal of closing the compression coverage gap while still in office. On March 6th, during our Lymphedema Lobby Days in DC, we presented Congressman Reichert with an award to show our appreciation. An excerpt of his moving remarks that followed can be seen here.

 

As seen in the video, Congressman Reichert states that CMS’s new receptivity has been prompted by the tremendous amount of congressional support the Lymphedema Treatment Act has garnered. Ultimately,
Secretary Azar and CMS may continue to maintain that a legislative fix is the only way to implement coverage, but, in the chance that their position may have shifted, Congressman Reichert is pursuing all possible paths to coverage.

Therefore, while it is exciting that HHS/CMS is showing a new interest and receptiveness, it is more important than ever that we continue our efforts to gain cosponsors and urge leadership offices to advance the LTA. That support and momentum are key to us obtaining coverage, regardless of the path that gets us there, legislative or regulatory.

Please continue to help us gain cosponsors and contact leadership offices in support of the LTA – apply constant pressure, in your lymphedema treatment and your advocacy!

Heather Ferguson
Founder & Executive Director
Lymphedema Advocacy Group
LymphedemaTreatmentAct.org