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In 2011....

July 12th:

H.R.2499 - Lymphedema Diagnosis and Treatment Cost Saving Act of 2011 was introduced in the 112th Congress (2011-2012) by Rep. Larry Kissel.

(H.R. 2499, 2011)

Description of the Bill

In 2014....

January 15th:

H.R. 3877 Lymphedema Treatment Act was introduced to the 113th Congress (2013-2014) by Rep. David G. Reichert.

In 2010...

What is Lymphedema?

(H.R. 3877, 2014)

The proposed Lymphedema Treatment Act (LTA) will help to improve coverage for the treatment of lymphedema. This will occur via amending the current Medicare statute, mentioned previously, to allow for coverage of compression supplies. This legislation was specifically proposed to a change in Medicare law, however, it would set an example for Medicaid and private insurers to follow suite

  • Currently an incurable phenomenon

  • Can be caused by injury, trauma, or congenital defects in the lymphatic system

  • It can lead to a multitude of complications including loss of lymphatic transport capacity leading to swelling, pain, disfigurement, and disability.

However, it can be managed with compression techniques, thus reducing these risks.

After several years of gaining sponsorship...

The Lymphedema Treatment Act was born!

(Lymphedema Treatment Act, 2011)

In 2015...

February 23rd:

Sponsored by Representative Larry Kissell, the first version of the LTA was introduced in the 111th Congress (2009-2010) as H.R.4662 - Lymphedema Diagnosis and Treatment Cost Saving Act of 2010 .

History and Origins

Details

The 114th Congress (2015-2016)

March 25th:

  • The House bill, H.R.1608 - The Lymphedema Treatment Act was introduced by Rep. David G. Reichert.

December 8th:

  • The Senate bill, an identical version, S.2372 -The Lymhedema Treatment Act was introduced by Sen. Maria Cantwell

According to House Bill 1608 (2015),

Medicare and other policies will not cover one of the vital components of lymphedema treatment, which is....

(H.R. 4662, 2010)

Compression Treatment Supplies

(H.R. 1608, 2015)

(S. 2372, 2015)

Clients with lymphedema are required to pay out of pocket.

Includes three sections:

(1) Short Title

(2) Findings

(3) Medicare Coverage of Certain Lymphedema Compression Treatment Items as Items of Durable Medical Equipment

Lymphedema compression treatment items are defined as:

  • "with respect to an individual, compression garments, devices, bandaging systems, components, and supplies" (3, iii, 1).
  • used in primary or custom medical treatment of lymphedema
  • prescribed by a physcian, PA, nurse practitioner, or clinical nurse specialist

Details Continued

According to House Bill 1608 (2015),

California and Louisiana have already recognized the importance of comprehensive treatment and require that private plans include coverage

(Lymphedema Treatment Act, 2011)

(H.R. 1608, 2015)

Lymphedema compression treatment items include:

  • multilayer compression bandaging systems
  • custom or standard fit gradient compression garments
  • non-elastic and elastic compression garments, compression wraps, and directional flow pads
  • any other compression garments, bandaging items, devices, and aids that the Sectretary determines as effective in preventing and treating lymphedema

The bill will become effective 180 days after being enacted

Comparitive Bills

(H.R. 1608, 2015)

H.R.2499 - Lymphedema Diagnosis and Treatment Cost-Saving Act of 2011

H.R.4662 - Lymphedema Diagnosis and Treatment Cost Saving Act of 2010

Two sections:

(1) Short Title

(2) Coverage of Lymphedema Diagnosis and Treatment Services Under Medicare

Lists additional compression treatment items:

  • aids and ancillary equipment
  • pneumatic appliances
  • replacement items

Includes a payment subsection

Two sections:

(1) Short Title

(2) Coverage of Lymphedema Diagnosis and Treatment Services Under Medicare

Lists physicians, OTs, PTs, nurse practitioners, PAs, clincial nurse speicalists, and chiropracters as adequate performers of treatment

Also includes subsections for:

  • manual lymph drainage
  • lymphedema self-management training
  • measurements to define treatment efficacy
  • follow-up treatment
  • denial
  • prohibition of additional treatment fees
  • special requirement on lymphedema pumps
  • general and special payment rules
  • requirements for suppliers of therapy compression items

Effective date is 90 days after bill is enacted

(H.R. 2499, 2011)

(H.R. 4662, 2010)

The Lymphedema Treatment Act

If the LTA is enacted...

Establishment of EBP

  • 20% - 70% improvement with compression

Reimbursement of compression treatment

Improvement of quality of life and outcomes for clients

Impact on OT

(Thrift & Squire, 2013)

The impact has the potential to be wide spread

Miranda, Jessica, Jordan, and Brandon

Lymphedema can be caused by various means; PVD, DVT, late affects of CHF, late affects of renal failure, chronic obesity, paralysis, and dependency positioning ...therefore, it can be observed in a variety of settings.

Settings could include acute, sub-acute, SNF, and homecare

References

(Rice, 2013)

Ethical Considerations

Lymphedema Diagnosis and Treatment Cost Saving Act of 2011, H.R. 2499,

112d Cong. (2011). Retrieved from https://www.congress.gov/bill/112th-congress/house-bill/2499/text

Lymphedema Diagnosis and Treatment Cost-Saving Act of 2010, H.R. 4662,

111d Cong. (2010). Retrieved from https://www.congress.gov/bill/111th-congress/house-bill/4662/text

Lymphedema Treatment Act (2011). Retrieved on March 18th from http://

lymphedematreatmentact.org/about-the-bill/

Lymphedema Treatment Act, H.R. 1608, 114d Cong. (2015). Retrieved from

https://www.congress.gov/bill/114th-congress/house-bill/1608/text

Lymphedema Treatment Act, S. 2373, 114d Cong. (2015). Retrieved from

https://www.congress.gov/bill/114th-congress/senate-bill/2373/text

Lymphedema Treatment Act, H.R. 3877, 113d Cong. (2014). Retrieved from

https://www.congress.gov/bill/113th-congress/house-bill/3877/text

Rice, L. (2013). Lymphedema in the skilled nursing setting. Retrieved on March

19th from http://www.allied-services.org/resources/lymphedema-treatment-in-the-skilled-nursing-setting/

Thrift, K., Squire, D. (2013). Utilizing complete decongestive therapy to treat

lymphedema: Evidence from contemporary literature: National Lymphedema Network, (25) 3. Retreived from http://www.lymphnet.org/membersOnly/dl/reprint/Vol_25/Vol_25-N3_Utilizing_CDT.pdf

Beneficence and Justice for all!

As OTs, we need to do the most good for our patients, as well as providing them equal opportunities to receive the best treatment options.

If the LTA is enacted, clients will be able to receive the treatment items they deserve through insurance. Today, only the clients that have the financial resources can receive the care that all individuals should have access to.

Thank you!

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