MEDICARE COVERAGE FOR COMPRESSION GARMENTS

Posted on February 14, 2023 | by Theresa

LYMPHEDEMA TREATMENT ACT

Currently, Medicare does not provide coverage for compression garments, a critical component of lymphedema treatment. However, you may have heard rumors that a new law has passed and that Medicare will soon pay for these compression garments. In fact, Congress recently passed the Lymphedema Treatment Act on December 23, 2022, which will enable Medicare to pay for compression garments starting next year. This law improves Medicare insurance coverage for medically necessary and doctor-prescribed compression garments. However, before this law can go into effect, there is much work yet to do.

Unfortunately, compression supplies can be costly without insurance assistance, which prevents some from being able to obtain the necessary treatment. In addition, this lack of compression garments for lymphedema can lead to many patients suffering from the worsening progression of their condition. Unfortunately, the Center for Medicare Services (C.M.S.) does not have the authority to add or redefine benefit categories. Only Congress can pass the necessary legislation to ensure these changes, allowing those with lymphedema to access the supplies they need.?

HOW IT ALL BEGAN

A passionate set of individuals and organizations pursued this process for over a decade. Heather Ferguson, the founder of the all-volunteer Lymphedema Advocacy Group (L.A.G.), spearheaded the first version of L.T.A., Lymphedema Diagnosis, and Treatment Cost Saving Act. In 2010 she proposed L.T.A. to the 111th Congress to address the estimated 3-5 million Americans who suffer from lymphedema. Then, working with her state representatives, Heather helped to introduce the federal Bill. Heather’s infant son was diagnosed with primary lymphedema, which motivated her cause. The Bill gained momentum in subsequent years, and in 2016, a Senate companion bill was introduced. As a result, Congress has steadily grown more support for the Bill.

PASSING OF THE BILL

Finally, the 117th Congress voted to pass the Bill as part of the Omnibus Appropriations Bill. Implementation of The Lymphedema Treatment Act (L.T.A.) will provide Medicare coverage for diagnosing lymphedema by amending the Medicare statute to allow 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. Furthermore, the Lymphedema Treatment Act will enable coverage of compression garments, which will go into effect on January 1, 2024.?

MORE WORK TO DO

Even though the Bill was passed into law, there is still much to address before the law can be implemented. Medicare will work with patient advocates, like L.A.G., and stakeholder groups through 2023. They will research and gather information to create the correct details and coverage for the Bill. This includes looking at the costs of compression garments from different companies and understanding the problems lymphedema patients face. In addition, Medicare will also talk to clinicians to set up guidelines for treatment coverage. This Bill will help improve insurance coverage for compression supplies and lower healthcare costs for patients with lymphedema.?

Yet to be determined is the number of garments that will be covered and the reimbursement rate of these garments. This could affect the availability of these compression garments. For example, some suppliers may not sell compression garments if the reimbursement rates are too low. This, in turn, could result in access issues in areas with insufficient suppliers.

TO LEARN MORE ABOUT THE BILL

If you would like to learn more about The Lymphedema Treatment Act, you can visit the LE&RN website. They have put together a list of Frequently asked questions regarding this subject. Consider joining this organization to help advocate and support those with lymphedema.

Disclaimer – This blog is for general information purposes only. Furthermore, the information in this blog is not a substitute for medical advice – always consult a licensed healthcare professional for advice on your specific condition.