Lymphedema Treatment Act

To amend title XVIII of the Social Security Act to provide for coverage of certain lymphedema compression treatment items under the Medicare program. 1. Short title This Act may be cited as the Lymphedema Treatment Act 2. Medicare coverage of certain lymphedema compression treatment items (a) Coverage (1) In general Section 1861 of the Social Security Act ( 42 U.S.C. 1395x (A) in subsection (s)(2)— (i) in subparagraph (GG), by striking and (ii) in subparagraph (HH), by striking the period at the end and inserting ; and (iii) by adding at the end the following new subparagraph: (II) lymphedema compression treatment items (as defined in subsection (lll)); ; and (B) by adding at the end the following new subsection: (lll) Lymphedema compression treatment items The term lymphedema compression treatment items (1) furnished on or after January 1, 2024, to an individual with a diagnosis of lymphedema for the treatment of such condition; (2) primarily and customarily used to serve a medical purpose and for the treatment of lymphedema, as determined by the Secretary; and (3) prescribed by a physician (or a physician assistant, nurse practitioner, or a clinical nurse specialist (as those terms are defined in section 1861(aa)(5)) to the extent authorized under State law). . (2) Payment (A) In general Section 1833(a)(1) of the Social Security Act ( 42 U.S.C. 1395l(a)(1) (i) by striking and (DD) (ii) by inserting before the semicolon at the end the following: and (EE) with respect to lymphedema compression treatment items (as defined in section 1861(lll)), the amount paid shall be equal to 80 percent of the lesser of the actual charge or the amount determined under the payment basis determined under section 1834(z) (B) Payment basis and limitations Section 1834 of the Social Security Act ( 42 U.S.C. 1395m (z) Payment for lymphedema compression treatment items (1) In general The Secretary shall determine an appropriate payment basis for lymphedema compression treatment items (as defined in section 1861(lll)). In making such a determination, the Secretary may take into account payment rates for such items under State plans (or waivers of such plans) under title XIX, the Veterans Health Administration, and group health plans and health insurance coverage (as such terms are defined in section 2791 of the Public Health Service Act), and such other information as the Secretary determines appropriate. (2) Frequency limitation No payment may be made under this part for lymphedema compression treatment items furnished other than at such frequency as the Secretary may establish. (3) Application of competitive acquisition In the case of lymphedema compression treatment items that are included in a competitive acquisition program in a competitive acquisition area under section 1847(a)— (A) the payment basis under this subsection for such items furnished in such area shall be the payment basis determined under such competitive acquisition program; and (B) the Secretary may use information on the payment determined under such competitive acquisition programs to adjust the payment amount otherwise determined under this subsection for an area that is not a competitive acquisition area under section 1847, and in the case of such adjustment, paragraphs (8) and (9) of section 1842(b) shall not be applied. . (3) Conforming amendment Section 1847(a)(2) of the Social Security Act ( 42 U.S.C. 1395w–3(a)(2) (D) Lymphedema compression treatment items Lymphedema compression treatment items (as defined in section 1861(lll)) for which payment would otherwise be made under section 1834(z). . (b) Inclusion in requirements for suppliers of medical equipment and supplies Section 1834 of the Social Security Act ( 42 U.S.C. 1395m (1) in subsection (a)(20)(D), by adding at the end the following new clause: (iv) Lymphedema compression treatment items (as defined in section 1861(lll)). . (2) in subsection (j)(5)— (A) by redesignating subparagraphs (E) and (F) as subparagraphs (F) and (G), respectively; and (B) by inserting after subparagraph (D) the following new subparagraph: (E) lymphedema compression treatment items (as defined in section 1861(lll)); . July 22, 2022 Reported from the Committee on Energy and Commerce July 22, 2022 Committee on Ways and Means

Summary: Lymphedema Treatment Act This bill provides for Medicare coverage of lymphedema compression treatment items. Specifically, the bill provides for coverage of standard and custom fitted gradient compression garments and other approved items that are prescribed by a physician or other specified health care professional to treat lymphedema.