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Risk Reduction in the News – Response from the NLN Medical Advisory Committee
2012 Conference featured in Oncology Times
Clinical Trials - Patient Participation
NLN Position Papers: Risk Reduction, Risk Reduction Summary, Diagnosis and Treatment, Exercise, Training, Breast Cancer-Related Lymphedema, Supplement BC-Related LE
As many of you know, the Women's Health and Cancer Rights Act (WHCRA) was signed into law on October 21, 1998. However, locating concrete information and the full text of this bill has been a challenge mainly because the Act appeared as provision Title IX under Subtitle IV of a much larger Omnibus bill, HR 4328. It is, in fact, this bill that passed, which included the Women's Health and Cancer Rights Act of 1998.
Under WHCRA -- according to HCFA and Linda Botten, OTR/L, CHT, ATP, the CPT Advisor for the AOTA to the Health Care Professionals Advisory Committee of the AMA HCPAC/AMA -- if you have coverage under a group health plan, or under an individual health insurance policy that covers medical and surgical benefits in connection with a mastectomy, the group health plan or issuer (an insurance company or HMO) must also provide coverage for reconstructive surgery in a manner determined in consultation with you and your attending physician. In addition, it requires coverage of:
"(1) all stages of reconstruction of the breast on which the mastectomy has been performed; (2) surgery and reconstruction of the other breast to produce a symmetrical appearance; and (3) prostheses and physical complications of mastectomy, including lymphedemas. Requires annual written notice of the availability of such benefits." (quoted from the actual text of WHCRA)
The most urgent question is: are only those women who have a mastectomy and opt for reconstructive surgery covered for lymphedema treatment? Three major sources say no. Blue Cross recently sent an updated report to its members which included the following announcement: "Women's Health and Cancer Rights Act of 1998 ... Requires that all enrollees eligible for mastectomy benefits also be covered for breast reconstruction, prostheses and physical complications of all stages of mastectomy, including lymphedemas." Linda Botten, OTR/L agrees with this translation, as do two sources at the Library of Congress National Reference Service in Washington, D.C (they bring us the "Thomas" government website at http://thomas.loc.gov/). The NLN is working to help clarify the wording of this Act and resubmit it as an update.
According to a congressional source, H.R. 4328 contains the same text that originally appeared in HR 164 (Eschoo) and Senate Bill 609 (Kennedy), and takes the title of a bill introduced by Sen. D'Amato known as S. 249 (this bill, if passed, would have been more or less a watered down version of S. 609, a version that did not include coverage for lymphedema). In essence, this means that S. 609 did pass! That in itself is a proud accomplishment since the NLN worked hand in hand with key legislators to create the text of the bill.
Of course, this legislation is one step on our journey towards a more comprehensive understanding of and coverage for lymphedema treatment in the United States. Hopefully, as physicians and clinicians across the country are forced to learn about lymphedema, and to find appropriate treatment for their patients, we will see a growing wave of awareness that will ultimately benefit all lymphedema patients. Until that time, we have something to celebrate! And a happy reminder that change does happen when we all work together towards a common goal.
The NLN sends out hearty congratulations to all who worked so hard on the passage of this bill.
- Mitchelle Tanner, Assistant Director
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