By: Robert Weiss, M.S., Chair NLN Legislative Committee
After ten years of hard work by scores of volunteers, we are taking the next step towards advancing the rights of lymphedema patients for access and coverage of treatment. In the year following Representative Larry Kissell's introduction of his H.R. 4662 "Lymphedema Diagnosis and Treatment Cost Saving Act of 2010" in the House of Representatives, the bill garnered 58 Cosponsors from both sides of the aisle and from across the political spectrum. This first comprehensive lymphedema bill to be introduced in Congress has been rewritten to reflect the suggestions of scores of lymphedema patients, therapists, suppliers, manufacturers and organizations into a new bill introduced by Representative Kissell in the 112th Congress.
Representative Kissell's H.R. 2499 IH Lymphedema Diagnosis and Treatment Cost-Saving Act of 2011 amends title XVIII (Medicare) of the Social Security Act to improve the diagnosis and treatment of lymphedema under the Medicare program, and to reduce costs under such program related to the treatment of lymphedema-related infection, disability and other complications. Specific provisions of the bill are as follows:
- Provides coverage of lymphedema diagnosis and treatment services for lymphedema from all causes (primary and secondary) in inpatient and outpatient settings for Medicare Beneficiaries according to the protocols of complex decongestive therapy;
- Defines qualified provider as any licensed medical or healthcare provider whose state licensing board recognizes lymphedema diagnosis, lymphedema treatment, or both to fall within the scope of practice of the medical or healthcare provider;
- Provides coverage for the differential diagnosis of lymphedema utilizing provider-determined diagnostic tools, for purposes of developing a lymphedema treatment plan;
- Provides coverage of the medically necessary treatment services as prescribed:
- Initial course of manual lymph drainage and compression;
- Follow-up courses of clinical treatment when medically required;
- Schedule, length and number of treatments as medically necessary;
- Compression materials and bandaging services;
- Self-management training of patient, family member, or aide;
- Any other modality approved by the Secretary;
- Coverage of clinical measurements prior to and after lymphedema diagnosis;
- Adds coverage of the compression treatment items used in the daily care of lymphedema as a new benefit category:
- Multilayer compression bandage systems and components;
- Custom or standard fit gradient compression garments;
- Elastic or low-elastic manually adjustable or fitted padded directional flow garments, with or without elastic or non-elastic compression jackets;
- Compression wraps and directional flow pads;
- Pneumatic appliances connected to and used in conjunction with pneumatic sequential compression controllers;
- Aids and ancillary equipment such as donning aids, bandage rollers, special shoes;
- Any other compression garments, bandaging systems, devices and aids as determined by the secretary to be effective in the prevention or treatment of lymphedema;
- Replacements as medically required for home use.
- Provides an exception to the statutory annual therapy cap for lymphedema treatment.
For the exact wording of H.R. 2499 and for the latest on its cosponsors, progress through Congress and related bills go to the THOMAS Library of Congress website http://thomas.loc.gov/home/thomas.php and enter the word "lymphedema" or the bill number "HR2499" into the search box.
Congressman Kissell's Lymphedema Diagnosis and Treatment Cost-Saving Act of 2011 H.R. 2499 IH should be supported vigorously. The bill promises to fill most of the gaps in Medicare coverage of lymphedema that have long been identified and are the sources of pain, expense, disability and patient non-adherence. It is estimated that enactment of this bill has the potential of saving Medicare hundreds of millions of dollars through prevention of lymphedema-related cellulitis [Weiss 2005].
Consideration should be given to restoring some of the patient protection provisions that were deleted from earlier versions, predominantly: the training and proficiency requirements for lymphedema therapists; inclusion of lymphedema-trained nurses, physicians and NPPs as providers of lymphedema services; requirement of lymphedema awareness for prescribing and referring physicians; manufacturer certification of garment fitters; and prohibition of denials by non-lymphedema-aware personnel. If you as a patient, or a therapist, feel that your patient protection concerns are not being met by this latest version of the bill, you may write to Congressman Kissell and express your opinions with a request that his bill be amended.
For the latest information on the bill, and live connections to your Congressional Representatives, go to the bill website http://www.lymphedematreatmentact.org.
Whatever the outcome of this bill, I strongly recommend that activities commence with the goal of changing C.F.R. 42 §484.4 Personnel Qualifications to define a new Medicare-qualified provider, i.e. "lymphedema therapist", with associated lymphedema training and certification accreditation requirements. The definition would define which licensed providers (e.g. PTs, OTs, S-LPs, physicians, NPPs and nurses), who, when adequately trained and certified as "proficient" by appropriate accrediting entities approved by the Secretary of DHHS, would be qualified to be reimbursed for providing lymphedema therapy to Medicare beneficiaries within the scope of their basic licensure.