Lymphedema Diagnosis and Treatment Cost Savings Act of 2011 - Amends title XVIII (Medicare) of the Social Security Act to extend coverage to lymphedema diagnosis and treatment services. including lymphedema compression treatment items.
[Congressional Bills 112th Congress]
[From the U.S. Government Publishing Office]
[H.R. 2499 Introduced in House (IH)]
112th CONGRESS
1st Session
H. R. 2499
To amend title XVIII of the Social Security Act to improve the
diagnosis and treatment of lymphedema under the Medicare program and to
reduce costs under such program related to the treatment of lymphedema.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
July 12, 2011
Mr. Kissell (for himself, Mr. Roe of Tennessee, Mr. Paul, Mr.
Blumenauer, Mr. Rangel, Ms. Brown of Florida, Mr. Coble, Mr. Holt, Ms.
Richardson, Mr. Connolly of Virginia, Mr. Michaud, Ms. Moore, Mr.
Jackson of Illinois, Ms. Norton, Mr. Miller of North Carolina, Mr.
Frank of Massachusetts, Mr. Schiff, and Mr. Price of North Carolina)
introduced the following bill; which was referred to the Committee on
Energy and Commerce, and in addition to the Committee on Ways and
Means, for a period to be subsequently determined by the Speaker, in
each case for consideration of such provisions as fall within the
jurisdiction of the committee concerned
_______________________________________________________________________
A BILL
To amend title XVIII of the Social Security Act to improve the
diagnosis and treatment of lymphedema under the Medicare program and to
reduce costs under such program related to the treatment of lymphedema.
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 Diagnosis and Treatment
Cost-Saving Act of 2011''.
SEC. 2. COVERAGE OF LYMPHEDEMA DIAGNOSIS AND TREATMENT SERVICES UNDER
MEDICARE.
(a) Coverage of Services.--Section 1861 of the Social Security Act
(42 U.S.C. 1395x) is amended--
(1) in subsection (s)(2)--
(A) in subparagraph (EE), by striking ``and'' at
the end;
(B) in subparagraph (FF), by adding ``and'' at the
end; and
(C) by adding at the end the following new
subparagraph:
``(GG)(i) lymphedema diagnosis services (as defined
in subsection (iii)(1)) and lymphedema treatment
services (as described in subsection (iii)(2)); and
``(ii) lymphedema compression treatment items (as
defined in subsection (jjj)).''; and
(2) by adding at the end the following new subsections:
``(iii) Lymphedema Diagnosis and Treatment Services.--(1)
Lymphedema Diagnosis Services.--The term `lymphedema diagnosis
services' means, with respect to an individual, the differential
diagnosis of the source of the individual's edema and the
identification of the specific etiology and functional lymphatic
deficiency, in which such diagnosis--
``(A) is provided by a provider, as defined in paragraph
(3), for the purpose of developing a lymphedema treatment plan;
and
``(B) may utilize any diagnostic tools the provider
determines to be reasonable and necessary.
``(2) Lymphedema Treatment Services.--The term `lymphedema
treatment services' means, with respect to an individual, services for
the treatment of lymphedema (regardless of cause)--
``(A) that are--
``(i) provided in an inpatient or outpatient
setting;
``(ii) provided by a provider, as defined in
paragraph (3), within the established scope of practice
of such provider; and
``(iii) medically necessary, in accordance with the
current standard of lymphedema treatment, including
complete decongestive therapy, which is a multi-modal
therapy comprising of manual lymph drainage,
compression therapy utilizing multilayer bandage
systems, compression garments and devices, exercise,
skin care, patient education, and any other lymphedema
treatment modalities determined by the Secretary to be
safe and effective; and
``(B) which shall--
``(i) include as medically necessary with respect
to the individual--
``(I) an initial evaluation and course of
clinical treatment, including initial baseline
measurements and subsequent measurements to
assess treatment efficacy and progress;
``(II) follow-up courses of clinical
treatment;
``(III) in the case that such individual
has cancer, clinical measurements, including
initial pre-operative baseline measurements and
periodic subsequent measurements to diagnose
the presence of lymphedema; and
``(IV) any other treatment modality
approved by the Secretary; and
``(ii) be provided in accordance with such
schedule, duration, and number of treatments as
determined medically necessary.
``(3) Provider Defined.--For purposes of this subsection and
subsection (jjj), the term `provider' means any licensed medical or
health care provider whose State licensing board recognizes lymphedema
diagnosis, lymphedema treatment, or both to fall within the scope of
practice of such medical or health care provider.
``(jjj) Lymphedema Compression Treatment Items.--The term
`lymphedema compression treatment items' means, with respect to an
individual, compression garments, devices, bandaging systems,
components, and supplies that are primarily and customarily used in the
medical treatment of lymphedema of the arms, hands, legs, feet, torso,
face and neck, breast and chest, abdomen, and genitalia, as prescribed
by a provider, as defined in subsection (iii)(3). Such term includes--
``(1) multilayer compression bandaging systems, including
short-stretch and medium-stretch compression bandages; cotton,
synthetic, or foam padding; gauze or elastic finger and toe
bandages; foam pads; directional flow padding; and tubular
bandages;
``(2) custom or standard fit gradient compression garments;
``(3) non-elastic and low-elastic compression garments,
manually adjustable or fitted padded directional flow garments
(with or without elastic or non-elastic compression jackets)
and compression wraps and directional flow pads;
``(4) aids and ancillary equipment consisting of donning
aids, bandage rollers, shoes to fit over compression items, and
other specialized items used with the items described in
paragraphs (1) through (3);
``(5) pneumatic appliances connected to and used in
conjunction with pneumatic sequential compression controllers;
``(6) any other compression garments, bandaging systems,
devices, and aids determined by the Secretary to be effective
in the prevention or treatment of lymphedema; and
``(7) replacements of any items under this subsection in
accordance with section 1834(p)(3).''.
(b) Payment.--
(1) Lymphedema compression treatment items.--
(A) In general.--Section 1833(a) of such Act (42
U.S.C. 1395l(a)) is amended--
(i) in paragraph (8), by striking at the
end ``and'';
(ii) in paragraph (9), by striking at the
end the period and inserting a semi-colon; and
(iii) by adding at the end the following
new paragraph:
``(10) in the case of lymphedema compression treatment
items described in section 1861(jjj), the amount determined
under section 1834(p); and''.
(B) Payment determined.--Section 1834 of such Act
(42 U.S.C. 1395m) is amended by adding at the end the
following new subsection:
``(p) Payment for Lymphedema Compression Treatment Items.--
``(1) General rule for payment.--
``(A) In general.--With respect to a lymphedema
compression treatment item as defined in section
1861(jjj)) for which payment is determined under this
subsection, subject to subparagraph (D), payment shall
be made in an amount equal to 80 percent of the payment
basis described in subparagraph (B).
``(B) Payment basis.--The payment basis described
in this subparagraph, with respect to a lymphedema
compression treatment item described in section
1861(jjj), is the actual charge for the item.
``(C) Exclusive payment rule for home health
agencies.--Notwithstanding any other provision of this
title, this subsection shall constitute the exclusive
provision of this title for payment for lymphedema
compression treatment items described in section
1861(jjj) under this part or under part A to a home
health agency or for such items that are furnished as
an incident to a physician's professional service.
``(2) Allowable quantities.--In the case it is determined
by a provider, as defined in section 1861(iii)(3), that
lymphedema compression treatment items are required as part of
lymphedema treatment services under section 1861(iii)(2), then
payment may be made under this title in accordance with this
subsection for such items in the quantity which is customary,
reasonable, and medically necessary.
``(3) Replacement of lymphedema compression treatment
items.--
``(A) In general.--Payment shall be made under this
subsection, with respect to an individual, for the
replacement of a lymphedema compression treatment item
if the period of the reasonable and useful lifetime of
the item (as described in subparagraph (B)) has expired
or a provider, as defined in section 1861(iii)(3),
determines that a replacement, or repair, of such item,
is medically necessary.
``(B) Reasonable and useful lifetime.--For purposes
of subparagraph (A), the period of the reasonable and
useful lifetime of a lymphedema compression treatment
item is as follows:
``(i) In the case of any item described in
section 1861(jjj)(1), 1 year.
``(ii) In the case of any item described in
section 1861(jjj)(2), 6 months.
``(iii) In the case of any item described
in section 1861(jjj)(3), 2 years.
``(iv) In the case of any item described in
section 1861(jjj)(4), 1 year.
``(v) In the case of any item described in
section 1861(jjj)(5), 5 years.
``(vi) In the case of any item described in
section 1861(jjj)(6), such period as determined
by the Secretary, in consultation with
appropriate health organizations, at the time
the Secretary determines such item to be
effective in the prevention or treatment of
lymphedema.''.
(C) Application of supplier requirements.--Section
1834(j)(5) of such Act (42 U.S.C. 1395m(j)(5)) is
amended--
(i) in subparagraph (E), by striking at the
end ``and'';
(ii) in subparagraph (F), by striking at
the end the period and inserting ``; and''; and
(iii) by adding at the end the following
new subparagraph:
``(G) lymphedema compression treatment items (as
defined in section 1861(jjj)).''.
(2) Lymphedema diagnosis and treatment services.--
(A) In general.--Section 1833(a) of such Act, as
amended by paragraph (1)(A), is further amended by
adding at the end the following new paragraph:
``(11)(A) in the case of lymphedema diagnosis services (as
defined in section 1861(iii)(1)) furnished by a provider (as
defined in section 1861(iii)(3)) the amount described in
section 1834(q); and
``(B) in the case of lymphedema treatment services (as
defined in section 1861(iii)(2)) furnished by a provider (as
defined in section 1861(iii)(3)) the amount described in
section 1834(k).''.
(B) Payment method.--Section 1834 of such Act, as
amended by paragraph (1)(B), is further amended by
adding at the end the following new subsection:
``(q) Payment for Outpatient Lymphedema Diagnosis and Treatment
Services by Physicians and Non-Physician Practitioners.--
``(1) In general.--For purposes of section 1833(a)(11), the
amount described in this subsection, with respect to a
lymphedema diagnosis service or lymphedema treatment service,
is 80 percent of the lesser of--
``(A) the actual charge for the service; or
``(B) the applicable fee schedule amount (as
defined in paragraph (2)) for the service.
``(2) Applicable fee schedule amount.--In this subsection,
the term `applicable fee schedule amount' means, with respect
to services furnished in a year, the amount determined under
the fee schedule established under section 1848 for such
services furnished during the year.''.
(C) Conforming amendment for payments under
1834(k).--Section 1834(k)(1) of such Act (42 U.S.C.
1395m(k)(1)) is amended by striking ``or 1833(a)(9)''
and inserting ``1833(a)(9), or 1833(a)(11)''.
(c) Effective Date.--The amendments made by this section shall
apply to items and services furnished on or after the date that is 180
days from the date of the enactment of this Act.
<all>
Introduced in House
Introduced in House
Referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Referred to the Subcommittee on Health.
Referred to the Subcommittee on Health.
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