March 6th is National Lymphedema Awareness Day and we would like to provide you with some information about very important legislation that needs to be passed.
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.
The Lymphedema Treatment Act (LTA) will improve coverage for the treatment of lymphedema from any cause by amending Medicare statute to allow for coverage of compression supplies.
Specific goals of the LTA are as follows:
- 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.
Please use the letter/example letter below to contact your Congressman about the very important and needed Lymphedema Treatment Act.
I hope that you will be an early cosponsor of the Lymphedema Treatment Act when it is reintroduced into the 114th Congress. Your support of this bipartisan legislation is very important to me, and I am disappointed that you did not cosponsor this bill during the 113th Congress.
The Lymphedema Treatment Act will enable Medicare to cover the doctor-prescribed compression therapy supplies that are the cornerstone of lymphedema treatment. Without compression patients cannot manage this chronic disease.
Inadequately treated lymphedema is progressive, leading to costly complications, co-morbidities and disability. Coverage of these medically necessary supplies will improve patient care while reducing the total healthcare costs associated with this potentially debilitating disease.
For additional information about the Lymphedema Treatment Act (HR 3877 in the 113th Congress) please contact Lindsay Manson, Senior Legislative Assistant to Congressman Reichert, at 202-225-7761 or lindsay.manson@mail.house.gov.
Thank you for your consideration, and I hope that I can count on you to cosponsor this important bill as soon as it is reintroduced.