One year ago today, we made lymphedema history – the House of Representatives voted on the Lymphedema Treatment Act (LTA) and it was passed with an astounding bipartisan vote of 402/13!
As members from both sides of the aisle passionately stated when they spoke in support of the bill, it was the patient advocates who made them care about this issue, which ultimately made it a priority for passage. You can watch their statements during the Committee Vote and Floor Speeches, which preceded the Full House Vote.
After the LTA was passed in the House, we focused on the Senate, and ultimately the LTA was signed into law last December, with coverage mandated to begin January 1, 2024. This past year we have been busy working through the implementation process, to ensure that the new coverage would meet the needs of patients. The recent release of the final rule was another big win for patients, as detailed in the summary below.
However, as the information below also demonstrates, our work is not done. Please consider making a donation of $50 or whatever is right for your budget, to support our continued efforts to make sure that all lymphedema patients have access to and insurance coverage for the treatments they need. Thank you!
 Pictured above, Heather Ferguson speaking at last month’s North America Lymphedema Summit. |
Last month, I had the privilege of representing the Lymphedema Advocacy Group at Forward Momentum: Future Steps in Lymphedema Management, hosted by the Lymphology Association of North America (LANA) in collaboration with the American Cancer Society (ACS).
The summit brought together researchers, training program directors, representatives from lymphedema related non-profit organizations, surgeons and physicians to present clinically relevant research, engage in workshops to synthesize evidence, evaluate current best practices, and identify strategies to move the field of lymphology forward.
Recordings of the following presentation can be viewed for FREE through the videos sections of the Public Learning Center on the LANA website:
- Current Diagnostic and Quantitative Techniques in the Field of Lymphedema Management.
- Current State of Evidence for CDT for BCRL.
- State of the Art-Lymphatic Surgery.
- The Effect of Compression Therapies, Devices and Pumps on Lymphedema Secondary to Cancer and Rapid Review and Evidence Map.
- Current Evidence on Patient Precautions for Reducing Breast Cancer-Related Lymphedema Manifestation and Progression Risks.
- The Influence of Non-Cancer-Related Risk Factors in the Development of Cancer-Related Lymphedema.
- Incidence of Lymphedema Related to Various Cancers and Their Treatments
- Workshop Summaries (preceded by a presentation about the Lymphedema Treatment Act)
The findings of the Summit presentations and Workshops will be published in late 2024, and we will share them with you at that time.
Below is a summary of the LTA final rule. You can read the full 65 pages here. We have also inserted notes into our group’s public comment document, which can be read here, to indicate which of our comments were incorporated into the final rule.
The final rule is a huge victory for patients, but our work is not done yet. Please visit our Take Action page if you have any insurance plan other than traditional Medicare and haven’t contacted your own insurance provider yet.
Lymphedema Treatment Act Final Rule Coverage Summary
What will be covered:
- Custom and standard fit daytime and nighttime garments.
- Custom and standard fit gradient compression wraps with adjustable straps.
- Bandaging supplies for any phase of treatment.
- Accessories including but not limited to donning and doffing aids, padding, fillers, linings, and zippers.
Frequency allowances:
- Daytime garments – 3 sets (one garment for each affected body part) every six months, standard or custom fit, or a combination of both
- Nighttime garments – 2 sets (one garment for each affected body part) every two years, standard or custom fit, or a combination of both
- Bandaging supplies – no set limit in the rule.
- Accessories – no set limit, will be determined on a case-by-case basis depending on the needs of the patient.
Coverage requirements:
- To be eligible for the above coverage, a patient must have been diagnosed with lymphedema and have a prescription for the compression supplies.
- The coverage will begin January 1, 2024. There will be no retroactive coverage, meaning, you cannot submit claims for any garments or supplies purchased or ordered before 1/1/2024.
Codes and reimbursement rates:
- Starting next year, there will be 81 HCPSC codes specifically for lymphedema compression supplies, most of which are new, and the rule also outlines the process for the creation of additional codes in the future if needed.
- The corresponding reimbursement rates for these codes will be released soon and are not included in the rule.
Deductibles and copay:
- For traditional Medicare — these supplies will be covered under Part B, so the annual Part B deductible and 20% coinsurance apply to all compression supplies.
- For Medicare Advantage and all other types of insurance — out-of-pocket costs will vary depending on the specific terms of your plan. It is likely that your compression supplies will be subject to the same copay and deductibles as supplies covered under the DMEPOS (Durable Medical Equipment, Prosthetic and Orthotic Supplies) section of your policy.
PLEASE NOTE: The final rule also outlines the process for making future changes to and/or additions to coverage if/when needed. This is very important, and ensures we will not be in the position of needing to get another law passed if adjustments to the coverage need to be made, or if new treatment supplies become available and need to be added to coverage.
Together, our advocacy made all of this possible!
Heather Ferguson
Founder & Executive Director
Lymphedema Advocacy Group
LymphedemaTreatmentAct.org
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