Lymphedema Treatment Act

To amend title XVIII of the Social Security Act to provide for Medicare coverage of certain lymphedema compression treatment items as items of durable medical equipment. 1. Short title This Act may be cited as the Lymphedema Treatment Act 2. Findings Congress makes the following findings: (1) Lymphedema is a chronic disease that results in an accumulation of protein-rich lymph fluid in parts of the body where lymph nodes or lymphatic vessels are damaged or inadequate. (2) Lymphedema afflicts millions of Americans, including men, women, and children who can be born with a primary form of lymphedema. The majority of cases, however, are secondary forms of lymphedema most often caused by cancer treatments that damage the body’s lymph transport and immune functions. (3) A 2010 peer-reviewed study in the American Cancer Society’s Cancer journal stated lymphedema is a common post-treatment condition [and] has been described as one of the most significant survivorship issues (4) Lymphedema is progressive when left untreated or under-treated and can put patients at greater risk for serious infections or other costly complications. (5) Congress acknowledged the importance of comprehensive lymphedema treatment coverage with passage of the Women’s Health and Cancer Rights Act of 1998, which requires group health plans, insurance companies, and health maintenance organizations to cover breast cancer-related lymphedema treatment post mastectomy and reconstruction. (6) Medicare beneficiaries with lymphedema currently lack coverage for compression therapy, an essential component of care they must use to manage their chronic disease. As a result, many patients cannot maintain their condition and experience an unnecessary loss of health and of function in the activities of daily living. (7) This Medicare coverage gap should be closed to help provide improved health care for lymphedema patients and in turn decrease the incidence of costly complications, co-morbidities and related disabilities. 3. Medicare coverage of certain lymphedema compression treatment items as items of durable medical equipment (a) In general Section 1861 of the Social Security Act ( 42 U.S.C. 1395x (1) in subsection (n), in the first sentence, by inserting before the semicolon the following: and includes lymphedema compression treatment items (as defined in subsection (iii)) (2) by adding at the end the following new subsection: (iii) Lymphedema compression treatment items The term lymphedema compression treatment items (1) means, with respect to an individual, compression garments, devices, bandaging systems, components, and supplies— (A) that are primarily and customarily used in the medical treatment of lymphedema; (B) as 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); and (C) which would not, other than under subsection (s)(6), be included as medical and other health services under this title; and (2) includes— (A) multilayer compression bandaging systems; (B) custom or standard fit gradient compression garments; (C) non-elastic and low-elastic compression garments and compression wraps and directional flow pads; and (D) any other compression garments, bandaging systems, devices, and aids determined by the Secretary to be effective in the prevention or treatment of lymphedema. . (b) Effective date The amendments made by subsection (a) shall apply to lymphedema compression treatment items furnished on or after 180 days after the date of the enactment of this Act.

Summary: Lymphedema Treatment Act This bill amends title XVIII (Medicare) of the Social Security Act to cover certain lymphedema compression treatment items as durable medical equipment under Medicare. (Lymphedema is a condition of localized fluid retention and tissue swelling that is caused when the lymphatic system is damaged or blocked.)