I 117th CONGRESS 2d Session H. R. 3630 IN THE HOUSE OF REPRESENTATIVES AN 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 ) 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)); . 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 . 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. Cheryl L. Johnson, Clerk.