By Robert (Bob) Weiss, MS, LE Legislative Advocate
The last issue of this column [LYMPHLink Vol. 22, No. 2 April-June 2010] discussed a decade of work attempting to change lymphedema coverage policy within current Medicare statutes by proposing that Centers for Medicare and Medicaid Services (CMS) consider 1)- changes to their national coverage determinations (NCDs) and local coverage determinations (LCDs) and 2)- changes to their interpretation of Medicare statutes. We are entering the second decade of the millennium and are undertaking a third and parallel approach to bringing medical care of lymphedema up to the standard of care recommended by all lymphology specialty groups—complex and or complete decongestive therapy (CDT).
Our Lymphedema Diagnosis and Therapy cost Saving Act of 2010 was introduced in the House of Representatives on February 23 by North Carolina Congressman Larry Kissell and was referred to House Health Subcommittees of the Committees on Energy and Commerce and on Ways and Means for consideration of such provisions which fall into the jurisdiction of the committees concerned. The bill amends title XVIII (Medicare) of the Social Security Act to extend coverage to lymphedema diagnosis and treatment services according to the current lymphedema standard of care. At the time of this writing there were 12 co-sponsors of H.R. 4662, about equally distributed between Democrats and Republicans. This healthcare bill is non-partisan.
Major provisions of the bill as introduced were outlined in the April 2010 issue, and include changes intended to rectify shortcomings in Medicare coverage of lymphedema treatment involving compression therapy supplies, qualifications of lymphedema therapists and garment fitters and annual limitations of therapy.
In 2001 Dr. Sean Tunis, then Director of the HCFA Coverage and Analysis Group stated:
“However, the supplies, namely, the compression garments used for the treatment of lymphedema do not fall within a separate benefit category set forth in the Social Security Act. Therefore, such garments could be covered not as a separate benefit but covered as "incident to" physical therapist services and paid as part of the physical therapy benefit. The Medicare program does not cover use of compression garments outside of the physical therapy services, as they do not meet any of the statutorily defined benefit categories.”
The bill would establish a new separate benefit category to cover the compression bandages, compression garments and compression devices used in the treatment of lymphedema. The Medicare Evidence Development Coverage Advisory Committee (MEDCAC) concluded at their meeting last November that existing evidence gives reasonable confidence that use of compression bandage systems and compression garments improve the health of lymphedema patients.
Other proposed changes in the bill are to provide reimbursement for lymphedema therapy services provided only by therapists who are specially trained and certified in the protocols of CDT. The exact wording of this provision is currently being discussed with representatives of APTA, AOTA and LANA and will be proposed to the Committees of Jurisdiction when H.R.4662 Committee mark-up starts.
We hope that by the time this column is published we will have a Senate version of the bill. A group of lymphedema activists will be traveling to Washington at the end of May to conduct Congressional Staff briefings and to sign up additional legislators, explain the need for and benefits of this lymphedema bill, and explain how the bill will save Medicare money. The team will be spearheaded by: Saskia R. J. Thiadens, Founder and Executive Director of NLN; Bob Weiss, lymphedema activist; Tim Daly, volunteer lobbyist; and Heather Ferguson that dynamo North Carolina mother who brought a lymphedema mandate to North Carolina, and found a sponsor for our lymphedema bill.
NLN has been actively pursuing coverage change for over 10 years to benefit the millions of U.S. lymphedema patients. It is time for lymphedema patients to tell their legislators why they need a change. Write to your Congressional Representative and urge him or her to sign on to H.R. 4662 as a co-sponsor. Write your Senators and request that they introduce a bill similar to H.R. 4662 in the Senate. And if your Representative is in either of the House Health Subcommittees, write to request that they move the bill to the floor of the House for a vote. More information including sample letters and search engines to find your Representatives may be found on our web page.
Robert "Bob" Weiss, M.S.
NLN LE Legislative Advocate