Lymphedema Treatment Act Passed by Congress

The Lymphedema Treatment Act is a federal law passed on December 23, 2022, that will go into effect on January 1, 2024, to improve Medicare insurance coverage for the medically necessary, doctor-prescribed compression supplies that are the cornerstone of lymphedema treatment. As with most bills, this was an exhaustive process that was persistently pursued for over a decade by a passionate set of individuals and organizations.

Currently, Medicare and other similar policies do not cover doctor-prescribed compression supplies used daily, and which are critical components, of lymphedema treatment. An estimated 3-5 million Americans suffer from lymphedema, a buildup of lymphatic fluid that can be painful and debilitating. Compression supplies can be costly without insurance assistance, and therefore, many patients suffer from worsening progression of their condition without the supplies needed to maintain it. The Center for Medicare Services (CMS) does not have the authority to add or redefine benefit categories, only Congress does, which explains the need for legislation.

Background

The first version of the LTA, entitled the Lymphedema Diagnosis and Treatment Cost Saving Act of 2010, was introduced in the 111^th Congress. This bill was spearheaded by Heather Ferguson, founder of the all-volunteer Lymphedema Advocacy Group (LAG), whose son was diagnosed with primary lymphedema as a baby. After spending his first years of life appealing denials of coverage for his expensive but needed compression garments, Heather worked with her state representatives and congresspeople to introduce a federal bill. The bill gained momentum in subsequent years and congresses. In 2016, a Senate companion bill was introduced. With each Congress, more and more support has been steadily gained.

Overview of the Congresses the bill was presented:

117^th Congress – 402 House Votes In-Favor thereby passing the Bill as part of the Omnibus Appropriations Bill, 68 Senate Votes In-Favor thereby passing the Bill (creating a new Medicare Part B benefit category).

What does the Lymphedema Treatment Act do?

The Lymphedema Treatment Act (LTA) will provide Medicare coverage for the diagnosis of Lymphedema by amending the Medicare statute to allow for coverage of compression supplies. Although this legislation relates specifically to a change in Medicare law, it would set a precedent for Medicaid and private insurers to follow.

The Lymphedema Treatment Act will amend Sec. 1861 [42 U.S.C. 1395x] of the Social Security Act to enable coverage of these items under Durable Medical Equipment.

The main highlights of the passing of this bill will be to:

• Improve insurance coverage for prescribed medical compression supplies
• Reduce total healthcare costs for patients with lymphedema

Timing?

The Lymphedema Treatment Act will amend Sec. 1861 [42 U.S.C. 1395x] of the Social Security Act to enable coverage of these items which will go into effect on January 1, 2024.  Medicare will be working with patient advocates and stakeholder groups like LAG through 2023 in order to research and gather information necessary to formulate the details of the bill and coverage properly. This includes researching garment costs submitted by compression garment companies, as well as learning the challenges faced by patients who live with lymphedema. Medicare will work with the clinician community to establish guidelines for treatment of coverage.