Lymphedema Treatment Act

Lymphedema Treatment Act

This bill amends title XVIII (Medicare) of the Social Security Act to cover certain lymphedema compression treatment items as durable medical equipment under Medicare. (Lymphedema is a condition of localized fluid retention and tissue swelling that is caused when the lymphatic system is damaged or blocked.)

[Congressional Bills 114th Congress]
[From the U.S. Government Publishing Office]
[H.R. 1608 Introduced in House (IH)]

114th CONGRESS
  1st Session
                                H. R. 1608

To amend title XVIII of the Social Security Act to provide for Medicare 
coverage of certain lymphedema compression treatment items as items of 
                       durable medical equipment.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                             March 25, 2015

     Mr. Reichert (for himself, Mr. Blumenauer, Mr. Lance, and Ms. 
 Schakowsky) 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 provide for Medicare 
coverage of certain lymphedema compression treatment items as items of 
                       durable medical equipment.

    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. FINDINGS.

    Congress makes the following findings:
            (1) Lymphedema is a chronic disease that results in an 
        accumulation of protein-rich lymph fluid in parts of the body 
        where lymph nodes or lymphatic vessels are damaged or 
        inadequate.
            (2) Lymphedema afflicts millions of Americans, including 
        men, women, and children who can be born with a primary form of 
        lymphedema. The majority of cases, however, are secondary forms 
        of lymphedema most often caused by cancer treatments that 
        damage the body's lymph transport and immune functions.
            (3) A 2010 peer-reviewed study in the American Cancer 
        Society's Cancer journal stated ``lymphedema is a common post-
        treatment condition [and] has been described as one of the most 
        significant survivorship issues''. The study reported an 
        overall cancer-related lymphedema incidence rate of 15.5 
        percent, with specific rates as follows: sarcoma 30 percent, 
        breast 20 percent, gynecological 20 percent, melanoma 16 
        percent, genital-urinary 10 percent, and head and neck 4 
        percent. Risk increased 22 percent after pelvic lymph node 
        removal and 31 percent after radiation therapy.
            (4) Lymphedema is progressive when left untreated or under-
        treated and can put patients at greater risk for serious 
        infections or other costly complications.
            (5) Congress acknowledged the importance of comprehensive 
        lymphedema treatment coverage with passage of the Women's 
        Health and Cancer Rights Act of 1998, which requires group 
        health plans, insurance companies, and health maintenance 
        organizations to cover breast cancer-related lymphedema 
        treatment post mastectomy and reconstruction.
            (6) Medicare beneficiaries with lymphedema currently lack 
        coverage for compression therapy, an essential component of 
        care they must use to manage their chronic disease. As a 
        result, many patients cannot maintain their condition and 
        experience an unnecessary loss of health and of function in the 
        activities of daily living.
            (7) This Medicare coverage gap should be closed to help 
        provide improved health care for lymphedema patients and in 
        turn decrease the incidence of costly complications, co-
        morbidities and related disabilities.

SEC. 3. MEDICARE COVERAGE OF CERTAIN LYMPHEDEMA COMPRESSION TREATMENT 
              ITEMS AS ITEMS OF DURABLE MEDICAL EQUIPMENT.

    (a) In General.--Section 1861 of the Social Security Act (42 U.S.C. 
1395x) is amended--
            (1) in subsection (n), in the first sentence, by inserting 
        before the semicolon the following: ``and includes lymphedema 
        compression treatment items (as defined in subsection (iii))''; 
        and
            (2) by adding at the end the following new subsection:
    ``(iii) Lymphedema Compression Treatment Items.--The term 
`lymphedema compression treatment items'--
            ``(1) means, with respect to an individual, compression 
        garments, devices, bandaging systems, components, and 
        supplies--
                    ``(A) that are primarily and customarily used in 
                the medical treatment of lymphedema;
                    ``(B) as 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); 
                and
                    ``(C) which would not, other than under subsection 
                (s)(6), be included as medical and other health 
                services under this title; and
            ``(2) includes--
                    ``(A) multilayer compression bandaging systems;
                    ``(B) custom or standard fit gradient compression 
                garments;
                    ``(C) non-elastic and low-elastic compression 
                garments and compression wraps and directional flow 
                pads; and
                    ``(D) any other compression garments, bandaging 
                systems, devices, and aids determined by the Secretary 
                to be effective in the prevention or treatment of 
                lymphedema.''.
    (b) Effective Date.--The amendment made by subsection (a) shall 
apply to lymphedema compression treatment items furnished on or after 
180 days after the date of the enactment of this Act.
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