Lymphedema Treatment Act
Bill: H.R.3630 | Sponsor: Rep. Schakowsky, Janice D. (D-IL)
Policy area: Health

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.

To amend title XVIII of the Social Security Act to provide for coverage 
 of certain lymphedema compression treatment items under the Medicare 
                                program.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Lymphedema Treatment Act''.

SEC. 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) is amended--
                    (A) in subsection (s)(2)--
                            (i) in subparagraph (GG), by striking 
                        ``and'' after the semicolon at the end;
                            (ii) in subparagraph (HH), by striking the 
                        period at the end and inserting ``; and''; 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' means standard and custom 
fitted gradient compression garments and other items determined by the 
Secretary that are--
            ``(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)) is amended--
                            (i) by striking ``, and'' before ``(EE)''; 
                        and
                            (ii) by inserting before the semicolon at 
                        the end the following: ``, and (FF) 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) is amended by 
                adding at the end the following new subsection:
    ``(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)) is amended by adding at 
        the end the following new subparagraph:
                    ``(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) is amended--
            (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));''.

SEC. 3. MEDICARE IMPROVEMENT FUND.

    Section 1898(b)(1) of the Social Security Act (42 U.S.C. 
1395iii(b)(1)) is amended by striking ``$7,308,000,000'' and inserting 
``$6,738,000,000''.

SEC. 4. DETERMINATION OF BUDGETARY EFFECTS.

    The budgetary effects of this Act, for the purpose of complying 
with the Statutory Pay-As-You-Go Act of 2010, shall be determined by 
reference to the latest statement titled ``Budgetary Effects of PAYGO 
Legislation'' for this Act, submitted for printing in the Congressional 
Record by the Chairman of the House Budget Committee, provided that 
such statement has been submitted prior to the vote on passage.

            Passed the House of Representatives November 17, 2022.

            Attest:

                                                                 Clerk.
117th CONGRESS

  2d Session

                               H. R. 3630

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