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Lymphland International Lymphedema Online
| I 111TH CONGRESS 2D SESSION H. R. 4662 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 complications of lymphedema, and for other purposes. IN THE HOUSE OF REPRESENTATIVES FEBRUARY 23, 2010 Mr. KISSELL 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 complications of lymphedema, and for other purposes. 1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 3 SECTION 1. SHORT TITLE. 4 This Act may be cited as the ‘‘Lymphedema Diag5 nosis and Treatment Cost Saving Act of 2010’’. VerDate Nov 24 2008 21:20 Feb 24, 2010 Jkt 089200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E: \BILLS\H4662.IH H4662 srobinson on DSKHWCL6B1PROD with BILLS 2 •HR 4662 IH 1 SEC. 2. COVERAGE OF LYMPHEDEMA DIAGNOSIS AND 2 TREATMENT SERVICES UNDER MEDICARE. 3 (a) COVERAGE OF SERVICES.—Section 1861 of the 4 Social Security Act (42 U.S.C. 1395x) is amended— 5 (1) in subsection (s)(2)— 6 (A) in subparagraph (DD), by striking 7 ‘‘and’’ at the end; 8 (B) in subparagraph (EE), by adding 9 ‘‘and’’ at the end; and 10 (C) by adding at the end the following new 11 subparagraph: 12 ‘‘(FF) lymphedema compression treatment 13 items (as described in subsection (iii)) and 14 lymphedema diagnosis and treatment services 15 (as described in subsection (hhh)) if such serv16 ices are prescribed by and reviewed by a treat17 ing physician and performed by such physician 18 or— 19 ‘‘(i) a physical therapist or an occupa20 tional therapist who meets the quality re21 quirements of subsection (hhh)(2)(C); 22 ‘‘(ii) a qualified professional, such as 23 a physician, nurse practitioner, clinical 24 nurse specialist, chiropractor, or physi25 cian’s assistant who is licensed or certified 26 by the State in which the services are per- VerDate Nov 24 2008 21:20 Feb 24, 2010 Jkt 089200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E: \BILLS\H4662.IH H4662 srobinson on DSKHWCL6B1PROD with BILLS 3 •HR 4662 IH 1 formed to perform therapy services and 2 who meets the quality requirements of 3 (hhh)(2)(C); or 4 ‘‘(iii) a qualified person, such as a 5 physical therapist assistant, occupational 6 therapy assistant, licensed massage thera7 pist, licensed practical nurse, or licensed 8 home health practitioner who meets the 9 quality requirements of (hhh)(2)(C) pro10 viding such services are rendered under the 11 direct supervision of a physical therapist or 12 occupational therapist qualified in 13 lymphedema treatment and management 14 who meets the quality requirements of 15 (hhh)(2)(C).’’; and 16 (2) by adding at the end the following new sub17 sections: 18 ‘‘(hhh) LYMPHEDEMA DIAGNOSIS AND TREATMENT 19 SERVICES.—(1) The term ‘lymphedema diagnosis and 20 treatment services’ means, with respect to an individual 21 and consistent with paragraph (3), differential diagnosis 22 and treatment of lymphedema (regardless of cause) ac23 cording to the current standard of lymphedema diagnosis 24 and treatment described in paragraph (2)(A) by, or under 25 the direction of, a health care professional that is a cer- VerDate Nov 24 2008 21:20 Feb 24, 2010 Jkt 089200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E: \BILLS\H4662.IH H4662 srobinson on DSKHWCL6B1PROD with BILLS 4 •HR 4662 IH 1 tified provider as described in paragraph (2)(B) in an out2 patient setting and that meets the quality standards de3 scribed in paragraph (2)(C), but only if the physician who 4 is managing the individual’s lymphedema certifies that 5 such services are needed under a comprehensive plan of 6 care related to the individual’s diagnosed lymphedema. 7 ‘‘(2) For purposes of paragraph (1): 8 ‘‘(A) The current standard of lymphedema di9 agnosis and treatment described in this subpara10 graph is such standard as defined by the American 11 Cancer Society and the International Society of 12 Lymphology and called ‘complex decongestive ther13 apy’, a multi-modal therapy comprising manual 14 lymph drainage, compression therapy, exercise, and 15 skin care. Such standard consists of the initial phase 16 of treatment which is performed by qualified health 17 care professionals on an outpatient basis (Phase 1 18 treatment) and the continuing maintenance phase 19 (Phase 2 treatment) which is performed in a home 20 setting by the patient, patient’s family, or patient’s 21 aide after receiving instruction described in para22 graph (5). 23 ‘‘(B) A qualified provider is a physician or 24 lymphedema therapist knowledgeable of the diag25 nosis and current medical standard of treatment of VerDate Nov 24 2008 21:20 Feb 24, 2010 Jkt 089200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E: \BILLS\H4662.IH H4662 srobinson on DSKHWCL6B1PROD with BILLS 5 •HR 4662 IH 1 lymphedema, or any other individual or entity des2 ignated by the Secretary, that, in addition to pro3 viding lymphedema outpatient self-management 4 training services (as defined in paragraph 5 (3)(C)(iii)), provides other items or services for 6 which payment may be made under this title. 7 ‘‘(C)(i) Subject to clause (ii), the quality stand8 ards described in this subparagraph are quality 9 standards established by the Secretary equivalent to 10 the practice standards established by the 11 Lymphology Association of North America. 12 ‘‘(ii) In applying this subsection during the 3- 13 year period beginning on the date of the enactment 14 of this subsection, a therapist who has completed at 15 least 135 hours of lymphedema treatment training 16 and is certified by the training school is deemed to 17 have met the requirement of clause (i), and may 18 practice under a certified provider within a plan of 19 care developed by the certified provider; regardless 20 of whether the therapist meets the experience stand21 ards established by the Lymphology Association of 22 North America. 23 ‘‘(D) The term ‘lymphedema diagnosis’ means 24 the differential diagnosis of the source of the pa25 tient’s edema and the identification of the specific VerDate Nov 24 2008 21:20 Feb 24, 2010 Jkt 089200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E: \BILLS\H4662.IH H4662 srobinson on DSKHWCL6B1PROD with BILLS 6 •HR 4662 IH 1 etiology in order to develop the lymphedema treat2 ment plan. Such term shall include diagnostic tools 3 such as the lymphoscintigraphic functional test or 4 other test the Secretary determines to be efficatious 5 to directly observe lymphatic system function may be 6 indicated if medical history or tests to rule out other 7 causes are not adequate to provide a clear positive 8 diagnosis of lymphedema. 9 ‘‘(3) COVERAGE.—With respect to lymphedema diag10 nosis and treatment services coverage under this part, the 11 following shall apply: 12 ‘‘(A) MANUAL LYMPH DRAINAGE.— 13 ‘‘(i) Lymphedema diagnosis and treatment 14 services coverage under this part shall include 15 an initial course of manual lymph drainage as 16 part of complete decongestive therapy (Phase 1) 17 when medically required by the qualified pro18 vider described in paragraph (2)(B). 19 ‘‘(ii) The schedule and number of manual 20 lymph drainage treatment sessions shall be de21 termined by the treating physician or 22 lymphedema therapist as required by medical 23 necessity, and not the limits governing rehabili24 tation therapy described in section 1833(g). VerDate Nov 24 2008 21:20 Feb 24, 2010 Jkt 089200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E: \BILLS\H4662.IH H4662 srobinson on DSKHWCL6B1PROD with BILLS 7 •HR 4662 IH 1 ‘‘(B) COMPRESSION BINDING SYSTEMS, GAR2 MENTS AND DEVICES.— 3 ‘‘(i) For purposes of this part, the mate4 rials and aids used in lymphedema compression 5 therapy— 6 ‘‘(I) while physically resembling items 7 in other benefit categories such as surgical 8 dressings, durable medical equipment, 9 splints and braces, orthotics and pros10 thetics described in subsections (s)(5), 11 (s)(6), and (s)(9), do not serve the same 12 medical function as such items in such 13 other categories and have significantly dif14 ferent therapeutic characteristics and uses; 15 and 16 ‘‘(II) are specified in subsection (iii) 17 as a separate benefit category. 18 ‘‘(ii) Such coverage shall include any com19 pression garments, binding systems and devices 20 described in subsection (iii) deemed by the pa21 tient’s qualified caregiver to be medically nec22 essary as part of the treatment of lymphedema. 23 ‘‘(iii) Such coverage shall include replace24 ments when required to maintain their medi25 cally required compressive function or to accom- VerDate Nov 24 2008 21:20 Feb 24, 2010 Jkt 089200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E: \BILLS\H4662.IH H4662 srobinson on DSKHWCL6B1PROD with BILLS 8 •HR 4662 IH 1 modate changes in the patient’s dimensions or 2 medical condition. 3 ‘‘(C) LYMPHEDEMA SELF-MANAGEMENT TRAIN4 ING.— 5 ‘‘(i) IN GENERAL.— 6 ‘‘(I) The initial course of treatment 7 (phase 1) described in paragraph (2)(A), 8 with respect to such services, shall include 9 training of the patient and an aide or fam10 ily member as required to perform self11 treatment in a home setting, including any 12 of the following home treatment modalities 13 which are determined by the qualified pro14 vider to be medically required and are a 15 part of the continuing maintenance phase 16 (phase 2) home treatment plan described 17 in paragraph (2)(A): 18 ‘‘(aa) Self-manual lymph drain19 age (simple lymph drainage). 20 ‘‘(bb) Compression bandaging. 21 ‘‘(cc) Donning and care of com22 pression garments. 23 ‘‘(dd) Performance of an appro24 priate decongestive exercise program. VerDate Nov 24 2008 21:20 Feb 24, 2010 Jkt 089200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E: \BILLS\H4662.IH H4662 srobinson on DSKHWCL6B1PROD with BILLS 9 •HR 4662 IH 1 ‘‘(ee) Use of specialized manually 2 adjustable compression devices, don3 ning aids, and other required ancillary 4 equipment; and if medically indicated. 5 ‘‘(ff) Use of sequential gradient 6 compression pneumatic pump. 7 ‘‘(II) As part of such treatment, pa8 tient training shall include instruction on 9 periodic self-measurements, skin care, indi10 cations of infection, and the steps to be 11 taken if infection occurs. 12 ‘‘(III) The term ‘lymphedema out13 patient self-management training services’ 14 means educational and training services 15 furnished to an individual diagnosed with 16 lymphedema by a certified provider (as de17 scribed in paragraph (2)(B)) in an out18 patient setting but only if the physician 19 who is managing the individual’s 20 lymphedema condition certifies that such 21 services are needed under a comprehensive 22 plan of care related to the individual’s 23 lymphedema condition. 24 ‘‘(ii) CONSULTATION WITH ORGANIZATIONS 25 IN ESTABLISHING PAYMENT AMOUNTS FOR VerDate Nov 24 2008 21:20 Feb 24, 2010 Jkt 089200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E: \BILLS\H4662.IH H4662 srobinson on DSKHWCL6B1PROD with BILLS 10 •HR 4662 IH 1 SERVICES PROVIDED BY PHYSICIANS.—In es2 tablishing payment amounts under section 1848 3 for physicians’ services consisting of 4 lymphedema outpatient self-management train5 ing services, the Secretary shall consult with 6 appropriate organizations, including such orga7 nizations representing individuals or Medicare 8 beneficiaries with lymphedema, in determining 9 the relative value for such services under sec10 tion 1848(c)(2). 11 ‘‘(D) MEASUREMENTS TO DEFINE TREATMENT 12 EFFICACY.—Periodic measurements shall be made to 13 enable evaluation of the efficacy of the treatment 14 plan and patient adherence, to modify the treatment 15 plan or to determine the need for follow-up courses 16 of treatment. 17 ‘‘(E) FOLLOW-UP TREATMENT.—Such coverage 18 shall provide for follow-up treatments whenever 19 medically required to periodically validate home tech20 niques, to monitor progress against the written 21 treatment plan, and to modify the treatment plan as 22 required. 23 ‘‘(F) DENIAL.—No individual other than a li24 censed physician or certified lymphedema therapist 25 competent to evaluate the specific clinical issues in- VerDate Nov 24 2008 21:20 Feb 24, 2010 Jkt 089200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E: \BILLS\H4662.IH H4662 srobinson on DSKHWCL6B1PROD with BILLS 11 •HR 4662 IH 1 volved in the care requested, may deny or modify re2 quests for authorization of health care services or 3 materials described in subsection (iii) pursuant to 4 this subsection. 5 ‘‘(G) PROHIBITION OF ADDITIONAL TREAT6 MENT FEES.—No additional fees or deductibles may 7 be assessed, with respect to such treatment, for com8 pliance with this title other than assessed for similar 9 medical services. 10 ‘‘(iii) LYMPHEDEMA COMPRESSION TREATMENT 11 ITEMS.— 12 ‘‘(1) DEFINITION.—The term ‘lymphedema 13 compression treatment item’ means compression 14 therapy materials and supplies used daily in the 15 medical treatment of lymphedema upon prescription 16 of the treating physician or therapist, including— 17 ‘‘(A) compression binding systems com18 prising, as medically required, short-stretch and 19 medium-stretch compression bandages; cotton, 20 synthetic, or foam padding; gauze or elastic fin21 ger and toe bandages; foam pads; and tubular 22 bandages; 23 ‘‘(B) compression garments and compres24 sion pads for compression treatment of VerDate Nov 24 2008 21:20 Feb 24, 2010 Jkt 089200 PO 00000 Frm 00011 Fmt 6652 Sfmt 6201 E: \BILLS\H4662.IH H4662 srobinson on DSKHWCL6B1PROD with BILLS 12 •HR 4662 IH 1 lymphedematous arms, legs, torso, face and 2 neck, breast and chest, abdomen, and genitalia; 3 ‘‘(C) manually-adjustable compression 4 sleeves and padded directional flow sleeves for 5 use on upper and lower limbs; 6 ‘‘(D) orthotic shoes; and 7 ‘‘(E) donning aids, bandage rollers, and 8 other specialized items used with the items de9 scribed in subparagraphs (A) through (D). 10 ‘‘(2) SPECIAL REQUIREMENT ON LYMPHEDEMA 11 PUMPS.—Such term shall include a pneumatic pump 12 for the treatment of lymphedema only if the treating 13 physician or therapist’s prescription for such pump 14 is accompanied by a certificate of medical necessity 15 which specifies as a minimum— 16 ‘‘(A) the differential diagnosis of 17 lymphedema and any related co-conditions such 18 as venous insufficiency, peripheral arterial dis19 ease, lipedema, morbid obesity, myxedema, and 20 any other condition which may be significant in 21 the selection of a type, specification, and usage 22 of the pump; and 23 ‘‘(B) the physician’s or therapist’s judge24 ment of the type and specifications of the pump 25 based on the patient’s medical necessity.’’. VerDate Nov 24 2008 21:20 Feb 24, 2010 Jkt 089200 PO 00000 Frm 00012 Fmt 6652 Sfmt 6201 E: \BILLS\H4662.IH H4662 srobinson on DSKHWCL6B1PROD with BILLS 13 •HR 4662 IH 1 (b) PAYMENT.— 2 (1) LYMPHEDEMA OUTPATIENT SELF-MANAGE3 MENT TRAINING SERVICES INCLUDED AS PHYSI4 CIANS’ SERVICES.—Section 1861(s)(2)(S) of such 5 Act (42 U.S.C. 1395x(s)(2)(S)) is amended by in6 serting ‘‘and lymphedema outpatient self-manage7 ment training services under subsection 8 (hhh)(3)(C)’’ after ‘‘subsection (qq))’’. 9 (2) LYMPHEDEMA COMPRESSION TREATMENT 10 ITEMS.— 11 (A) IN GENERAL.—Section 1833(a) of 12 such Act (42 U.S.C. 1395l(a)) is amended— 13 (i) in paragraph (8), by striking at 14 the end ‘‘and’’; 15 (ii) in paragraph (9), by striking at 16 the end the period and inserting a semi17 colon; and 18 (iii) by adding at the end the fol19 lowing new paragraph: 20 ‘‘(10) in the case of lymphedema compression 21 treatment items described in section 1861(iii), the 22 amount determined under section 1834(n); and’’. 23 (B) PAYMENT DETERMINED.—Section 24 1834 of such Act (42 U.S.C. 1395m) is amend- VerDate Nov 24 2008 21:20 Feb 24, 2010 Jkt 089200 PO 00000 Frm 00013 Fmt 6652 Sfmt 6201 E: \BILLS\H4662.IH H4662 srobinson on DSKHWCL6B1PROD with BILLS 14 •HR 4662 IH 1 ed by adding at the end the following new sub2 section: 3 ‘‘(n) PAYMENT FOR LYMPHEDEMA COMPRESSION 4 TREATMENT ITEMS.— 5 ‘‘(1) GENERAL RULE FOR PAYMENT.— 6 ‘‘(A) IN GENERAL.—With respect to a 7 lymphedema compression treatment item de8 scribed in section 1861(iii) for which payment 9 is determined under this subsection, subject to 10 subparagraph (D), payment shall be made in an 11 amount equal to 80 percent of the payment 12 basis described in subparagraph (B). 13 ‘‘(B) PAYMENT BASIS.—The payment 14 basis described in this subparagraph, with re15 spect to a lymphedema compression treatment 16 item described in section 1861(iii), is the actual 17 charge for the item. 18 ‘‘(C) EXCLUSIVE PAYMENT RULE FOR 19 HOME HEALTH AGENCIES.—This subsection 20 shall constitute the exclusive provision of this 21 title for payment for lymphedema compression 22 treatment items described in section 1861(iii) 23 under this part or under part A to a home 24 health agency. 25 ‘‘(D) EXCEPTIONS.— VerDate Nov 24 2008 21:20 Feb 24, 2010 Jkt 089200 PO 00000 Frm 00014 Fmt 6652 Sfmt 6201 E: \BILLS\H4662.IH H4662 srobinson on DSKHWCL6B1PROD with BILLS 15 •HR 4662 IH 1 ‘‘(i) Subparagraph (B) shall not apply 2 to an item furnished by a public home 3 health agency (or by another home health 4 agency which demonstrates to the satisfac5 tion of the Secretary that a significant por6 tion of its patients are low income) free of 7 charge or at nominal charges to the public. 8 ‘‘(ii) Subparagraph (B) shall not 9 apply to items that are furnished as an in10 cident to a physician’s professional service. 11 ‘‘(2) SPECIAL PAYMENT RULES.— 12 ‘‘(A) ALLOWABLE ITEMS.—To be eligible 13 for payment under this subsection, an item de14 scribed in section 1861(iii) must— 15 ‘‘(i) be ordered by a qualified physi16 cian or lymphedema therapist for treat17 ment of diagnosed lymphedema; 18 ‘‘(ii) primarily and customarily be 19 used to serve a medical purpose; 20 ‘‘(iii) generally not be useful to a per21 son in the absence of an illness or injury; 22 and 23 ‘‘(iv) be appropriate for use in the 24 home. VerDate Nov 24 2008 21:20 Feb 24, 2010 Jkt 089200 PO 00000 Frm 00015 Fmt 6652 Sfmt 6201 E: \BILLS\H4662.IH H4662 srobinson on DSKHWCL6B1PROD with BILLS 16 •HR 4662 IH 1 ‘‘(B) ALLOWABLE QUANTITIES.—In the 2 case it is determined by the qualified physician 3 or qualified lymphedema therapist involved that 4 compression therapy demands daily compression 5 as part of lymphedema treatment according to 6 section 1861(hhh)(1), then payment may be 7 made in accordance with this subsection for the 8 following quantities— 9 ‘‘(i) in the case of compression bind10 ing systems described in section 11 1861(iii)(1)(A), 2 sets for each affected 12 body part; 13 ‘‘(ii) in the case of compression gar14 ments described in section 1861(iii)(1)(B), 15 2 garments for each affected body part; 16 ‘‘(iii) in the case of compression de17 vices described in section 1861(iii)(1)(C), 1 18 each for each affected body part; and 19 ‘‘(iv) in the case of compression ther20 apy aids described in section 21 1861(iii)(1)(D), as determined by the 22 qualified physician or qualified 23 lymphedema therapist. 24 ‘‘(C) ALLOWABLE USE.—Payment may be 25 made under this subsection for a lymphedema VerDate Nov 24 2008 21:20 Feb 24, 2010 Jkt 089200 PO 00000 Frm 00016 Fmt 6652 Sfmt 6201 E: \BILLS\H4662.IH H4662 srobinson on DSKHWCL6B1PROD with BILLS 17 •HR 4662 IH 1 compression treatment item described in section 2 1861(iii) only if such item— 3 ‘‘(i) is prescribed by a certified pro4 vider as defined in section 5 1861(hhh)(2)(B); 6 ‘‘(ii) is used as part of a lymphedema 7 treatment plan described in section 8 1861(hhh)(1); 9 ‘‘(iii) is used by a patient who has 10 been instructed in lymphedema self-man11 agement described in section 12 1861(hhh)(5); and 13 ‘‘(iv) is used to treat a diagnosed con14 dition of chronic lymphedema. 15 ‘‘(D) COMPRESSION RANGE.—The 16 lymphedema compression treatment items for 17 which payment may be made under this section 18 must provide a compression no less than 19 30mmHg and no greater than 60mmHg. 20 ‘‘(E) QUALIFIED FITTERS.—The 21 lymphedema compression treatment items for 22 which payment may be made under this section 23 must be measured and fitted by a qualified fit24 ter who is an individual who— VerDate Nov 24 2008 21:20 Feb 24, 2010 Jkt 089200 PO 00000 Frm 00017 Fmt 6652 Sfmt 6201 E: \BILLS\H4662.IH H4662 srobinson on DSKHWCL6B1PROD with BILLS 18 •HR 4662 IH 1 ‘‘(i) is a qualified lymphedema thera2 pist, as defined in section 1834(o)(2), who 3 meets the quality standards of section 4 1861(hhh)(2)(C); 5 ‘‘(ii) in the case of a State that pro6 vides for the licensing of orthotists and 7 prosthetists, is licensed in orthotics or 8 prosthetics by the State in which the item 9 is supplied; 10 ‘‘(iii) in the case of a State that does 11 not provide for the licensing of orthotists 12 and prosthetists, is specifically trained and 13 educated to provide or manage the provi14 sion of prosthetics and custom-designed or 15 -fabricated orthotics, and is certified by the 16 American Board for Certification in 17 Orthotics and Prosthetics, Inc. or by the 18 Board for Orthotist/Prosthetist Certifi19 cation, or is credentialed and approved by 20 a program that the Secretary determines, 21 in consultation with appropriate experts in 22 orthotics and prosthetics, has training and 23 education standards that are necessary to 24 provide such prosthetics and orthotics; or VerDate Nov 24 2008 21:20 Feb 24, 2010 Jkt 089200 PO 00000 Frm 00018 Fmt 6652 Sfmt 6201 E: \BILLS\H4662.IH H4662 srobinson on DSKHWCL6B1PROD with BILLS 19 •HR 4662 IH 1 ‘‘(iv) is certified by the qualified man2 ufacturer of the item to be qualified to fit 3 the particular garment or device. 4 ‘‘(F) REQUIREMENTS FOR SUPPLIERS OF 5 COMPRESSION THERAPY ITEMS.—A supplier of 6 the lymphedema compression treatment items 7 described in this subsection must meet the re8 quirements of section 1834(j) in order to re9 ceive payment under this subsection. 10 ‘‘(3) REPLACEMENT OF COMPRESSION THERAPY 11 ITEMS.— 12 ‘‘(A) IN GENERAL.—Payment shall be 13 made under this subsection, with respect to an 14 individual, for the replacement of compression 15 bindings, compression garments, or compression 16 devices if an ordering physician determines that 17 the provision of a replacement item, or repair of 18 such an item, is necessary because of any of the 19 following: 20 ‘‘(i) A change in the physiological or 21 medical condition of the individual. 22 ‘‘(ii) A loss of required compression of 23 the item that is not restorable by washing 24 and drying. VerDate Nov 24 2008 21:20 Feb 24, 2010 Jkt 089200 PO 00000 Frm 00019 Fmt 6652 Sfmt 6201 E: \BILLS\H4662.IH H4662 srobinson on DSKHWCL6B1PROD with BILLS 20 •HR 4662 IH 1 ‘‘(iii) An irreparable change in the 2 condition of the device, or in a part of the 3 device. 4 ‘‘(B) LENGTH OF REASONABLE USEFUL 5 LIFETIME.—The reasonable useful lifetime of a 6 lymphedema compression treatment item de7 scribed in section 1861(iii) shall be as follows, 8 except that, if the Secretary determines that, on 9 the basis of prior experience in making pay10 ments for such an item under this title, such 11 lifetimes are no longer appropriate with respect 12 to a particular item, the Secretary shall estab13 lish an alternative reasonable lifetime for such 14 item: 15 ‘‘(i) COMPRESSION BINDING KIT.—In 16 the case of compression binding systems 17 described in section 1861(iii)(1)(A), the 18 greater of 6 months or per manufacturer’s 19 warrantee. 20 ‘‘(ii) COMPRESSION GARMENTS.—In 21 the case of compression garments de22 scribed in section 1861(iii)(1)(B), the 23 greater of 4 months or per manufacturer’s 24 warrantee. VerDate Nov 24 2008 21:20 Feb 24, 2010 Jkt 089200 PO 00000 Frm 00020 Fmt 6652 Sfmt 6201 E: \BILLS\H4662.IH H4662 srobinson on DSKHWCL6B1PROD with BILLS 21 •HR 4662 IH 1 ‘‘(iii) COMPRESSION DEVICES.—In the 2 case of compression devices described in 3 section 1861(iii)(1)(C), the greater of 3 4 years or per manufacturer’s warrantee. 5 ‘‘(iv) AIDS.—In the case of compres6 sion therapy aids described in section 7 1861(iii)(1)(D), as required to maintain 8 functional usefulness.’’. 9 (C) SUPPLIER REQUIREMENTS.—Section 10 1834(j)(5) of such Act (42 U.S.C. 1395m(j)(5)) 11 is amended— 12 (i) in subparagraph (E), by striking 13 at the end ‘‘and’’; 14 (ii) in subparagraph (F), by striking 15 at the end the period an inserting ‘‘; and’’; 16 and 17 (iii) by adding at the end the fol18 lowing new subparagraph: 19 ‘‘(G) lymphedema compression treatment 20 items (as described in section 1861(iii)).’’. 21 (3) LYMPHEDEMA DIAGNOSIS AND TREATMENT 22 SERVICES.— 23 (A) IN GENERAL.—Section 1833(a) of 24 such Act, as amended by paragraph (2)(A), is VerDate Nov 24 2008 21:20 Feb 24, 2010 Jkt 089200 PO 00000 Frm 00021 Fmt 6652 Sfmt 6201 E: \BILLS\H4662.IH H4662 srobinson on DSKHWCL6B1PROD with BILLS 22 •HR 4662 IH 1 further amended by adding at the end the fol2 lowing new paragraph: 3 ‘‘(11) with respect to lymphedema diagnosis 4 and treatment services (as defined in subsection 5 (hhh)(1))— 6 ‘‘(A) furnished by a qualified physical ther7 apist or qualified occupational therapist, as de8 fined in section 1834(o)(2)(A), the amounts de9 scribed in section 1834(k); or 10 ‘‘(B) furnished by a lymphedema therapist, 11 as defined by 1834(o)(2)(B), under direction of 12 a qualified physical therapist or qualified occu13 pational therapist, the amounts described in 14 section 1834(o).’’. 15 (B) PAYMENT METHOD.—Section 1834 of 16 such Act, as amended by paragraph (2)(B), is 17 further amended by adding at the end the fol18 lowing new subsection: 19 ‘‘(o) PAYMENT FOR OUTPATIENT LYMPHEDEMA DI20 AGNOSIS AND TREATMENT SERVICES.— 21 ‘‘(1) IN GENERAL.—For purposes of section 22 1833(a)(11)(B), in the case of lymphedema diag23 nosis and treatment services described in section 24 1861(hhh) for which payment is determined under 25 this subsection and that are performed by a quali- VerDate Nov 24 2008 21:20 Feb 24, 2010 Jkt 089200 PO 00000 Frm 00022 Fmt 6652 Sfmt 6201 E: \BILLS\H4662.IH H4662 srobinson on DSKHWCL6B1PROD with BILLS 23 •HR 4662 IH 1 fied lymphedema therapist (as defined in paragraph 2 (2)) under the direction of a qualified physician 3 therapist or qualified occupational therapist, the 4 payment basis shall be 80 percent of the lesser of— 5 ‘‘(A) the actual charge for the service; or 6 ‘‘(B) the applicable fee schedule amount 7 (as defined in paragraph (3)) for the services. 8 ‘‘(2) QUALIFIED THERAPISTS.—For purposes of 9 this subsection: 10 ‘‘(A) IN GENERAL.—The term ‘qualified’, 11 with respect to a physical therapist, occupa12 tional therapist, or lymphedema therapist, 13 means that the physical therapist, occupational 14 therapist, or lymphedema therapist meets the 15 quality requirements described in section 16 1861(hhh)(2)(C). 17 ‘‘(B) LYMPHEDEMA THERAPIST.—The 18 term ‘lymphedema therapist’ means any of the 19 following individuals so long as such individual 20 is legally authorized to practice by the State in 21 which the lymphedema diagnosis and treatment 22 service involved is performed and meets the 23 quality requirements described in subparagraph 24 (A): VerDate Nov 24 2008 21:20 Feb 24, 2010 Jkt 089200 PO 00000 Frm 00023 Fmt 6652 Sfmt 6201 E: \BILLS\H4662.IH H4662 srobinson on DSKHWCL6B1PROD with BILLS 24 •HR 4662 IH 1 ‘‘(i) A registered nurse, nurse practi2 tioner, family nurse practitioner or clinical 3 nurse specialist (as described in section 4 1861(aa)(5)). 5 ‘‘(ii) A doctor of medicine or doctor of 6 osteopathy (as described in section 7 1861(r)(1). 8 ‘‘(iii) A physician assistant (as de9 scribed in section 1861(aa)(5)). 10 ‘‘(iv) A chiropractor. 11 ‘‘(v) A licensed massage therapist. 12 ‘‘(vi) A licensed home health practi13 tioner. 14 ‘‘(3) APPLICABLE FEE SCHEDULE AMOUNT.— 15 In this subsection, the term ‘applicable fee schedule 16 amount’ means, with respect to services furnished in 17 a year, the amount determined under the fee sched18 ule established under section 1848 for such services 19 furnished during the year or, if there is no such fee 20 schedule established for such services, the amount 21 determined under the fee schedule established for 22 such comparable services as the Secretary specifies. 23 ‘‘(4) UNIFORM CODING.—For claims for serv24 ices for which the amount of payment is determined 25 under this subsection, the claim shall include a code VerDate Nov 24 2008 21:20 Feb 24, 2010 Jkt 089200 PO 00000 Frm 00024 Fmt 6652 Sfmt 6201 E: \BILLS\H4662.IH H4662 srobinson on DSKHWCL6B1PROD with BILLS 25 •HR 4662 IH 1 (or codes) under a uniform coding system specified 2 by the Secretary that identifies the services fur3 nished. 4 ‘‘(5) RESTRAINT ON BILLING.—The provisions 5 of subparagraphs (A) and (B) of section 6 1842(b)(18) shall apply to lymphedema diagnosis 7 and treatment services for which payment is made 8 under this subsection in the same manner as they 9 apply to services provided by a practitioner described 10 in section 1842(b)(18)(C), except that in applying 11 such subparagraphs the practitioner described shall 12 be any practitioner described in paragraph (2)(B).’’. 13 (C) EXCLUSION FROM CERTAIN THERAPY 14 SERVICES.—Section 1833(g)(4) of such Act (42 15 U.S.C. 1395l(g)(4)) is amended by inserting 16 ‘‘or to expenses incurred with respect to 17 lymphedema diagnosis and treatment services 18 (as defined in subsection (hhh)(1))’’ before the 19 period at the end. 20 (c) EFFECTIVE DATE.—The amendments made by 21 this section shall apply to items and services furnished on 22 or after the date that is 90 days from the date of the 23 enactment of this Act. Æ VerDate Nov 24 2008 21:20 Feb 24, 2010 Jkt 089200 PO 00000 Frm 00025 Fmt 6652 Sfmt 6301 E: \BILLS\H4662.IH H4662 srobinson on DSKHWCL6B1PROD with BILLS |
| IN THE SENATE/HOUSE 12/15/09 MR. KISSELL introduced the following bill: A BILL: to provide diagnosis and treatment of individuals with and at risk for lymphedema according to current medical treatment standards with the goal of reducing total healthcare costs through avoidance of periodic infections, pain and disabilities resulting from this medical condition; to enhance quality of lymphedema patient care by providing therapist qualification requirements; to provide for informed consent of patients requiring surgery and radiotherapy of the relative risks of lymphedema for alternate treatments considered; to provide for lymphedema patient education in the procedures for self-treatment so as to transfer the treatment from the clinical to the home setting; to encourage patient self-treatment plan compliance by providing necessary medical supplies for use at home; to expand patient access to qualified lymphedema therapy by extending coverage to qualified, trained lymphedema therapists who may practice under a qualified physician, physical therapist or occupational therapist. *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 & Treatment Cost Saving Act of 2010" SECTION 2. SUMMARY. This Act amends Title XVIII of the Social Security Act, specifically to: 1. add lymphedema diagnosis and treatment services to the scope of Part B services in section 1832 [42 U.S.C. 1395k]; 2. define the newly added services in section 1861 [42 U.S.C. 1395x]; 3. add a new benefit category for compression therapy medical items to section 1861 [42 U.S.C. 1395x]; 4. add lymphedema patient training to section 1861 [42 U.S.C. 1395x]; 5. provide payment rules for compression therapy items to Section 1834 [42 U.S.C. 1395m] and for therapist services to Section 1833 [42 U.S.C. 1395l]; 6 add a new health professional category of "certified lymphedema therapist" to 1861 [42 U.S.C. 1395x] with definition of qualification requirements. SECTION 3. PROVISIONS. TITLE XVIII--HEALTH INSURANCE FOR THE AGED AND DISABLED of the Social Security Act is amended as follows: (a). LYMPHEDEMA TREATMENT COVERAGE of costs of diagnosis and treatment of lymphedema from all sources. (1*) LYMPHEDEMA DIAGNOSIS AND TREATMENT SERVICES*--Section 1832 [42 U.S.C. 1395k] is amended in subsection (a)(2) by adding lymphedema diagnosis and treatment and compression therapy as covered services: * * *"(K) lymphedema diagnosis and treatment services for treatment of lymphedema from all causes (as described in section 1861 (ccc)); and* * * *(L) coverage of medically-necessary lymphedema compression treatment items (as described in section 1861 (s)(18))." * (2) *DEFINITIONS*--Section 1861 [42 U.S.C. 1395x] is amended to define patient education and training and lymphedema diagnosis and treatment services: (A) *PATIENT EDUCATION AND TRAINING*--in subsection (s)(2)(S)-- (i) by adding "*and lymphedema*" after " *diabetes*"; and (ii) by adding "*and subsection (ccc)*" after *" subsection (qq)*"; and (B) *LYMPHEDEMA DIAGNOSIS AND TREATMENT SERVICES*--by adding at the end the following new subsection: *"Lymphedema Diagnosis and Treatment Services* * * *"(ccc)(1) LYMPHEDEMA DIAGNOSIS AND TREATMENT SERVICES-- The term "lymphedema diagnosis and treatment services" means differential diagnosis and treatment of lymphedema according to current medical standards of lymphedema treatment (i.e. "complex decongestive therapy") described in paragraph (2)(A) by, or under the direction of, a certified provider as described in paragraph (2)(B) in an outpatient setting by an individual or entity who meets the quality standards described in paragraph (2)(C), but only if the physician who is managing the individual's lymphedema condition certifies that such services are needed under a comprehensive plan of care related to the individual's diagnosed lymphedema condition.* * * * (2) DEFINITIONS-- In paragraph (1)--* * (A) The current standard of lymphedema diagnosis and treatment as defined by the American Cancer Society and the International Society of Lymphoology. ---------------- A celebration of women in the 111th Congress by Larry Kissell In honor of all the women of the 8th Congressional district, and in celebration of the Women’s History Month, I want to tell you a little bit about some of what I’ve done to address women’s issues in the 111th Congress. As your Congressman, I get the opportunity to meet remarkable people like Heather Ferguson, a Charlotte mom fighting to help her three-year-old son, and others like him, to get critical treatment for lymphedema. Heather struggled to get her health insurance to pay for the relatively-inexpensive treatment to help her son live a normal life without the serious complications of untreated lymphedema. She knew if she didn’t do something, she would be fighting with this issue her entire life. So she took the issue to her state representative, another great woman, Tricia Cotham, and then, brought her issue to me. Together, we introduced legislation to ensure Medicare covers treatment for lymphedema sufferers. One of the largest groups of lymphedema sufferers are cancer patients. The condition can be caused by cancer treatments that affect the lymphatic system. Breast cancer patients are especially susceptible to lymphedema. Breast cancer is the leading cause of cancer death in women ages 15 to 54. As we all know too well, one in eight of all women will get breast cancer in her lifetime. Yet, more than 60 percent of breast cancer occurrences are detected in early stages. If detected early, 96 percent of women are cancer-free after five years. Breast cancer can strike at any age. As we know, educating our daughters about early detection is one of the most critical things we can do. In an effort to promote early detection, I have joined my colleagues in sponsoring a bill to increase breast cancer awareness in young women and provide support for young women diagnosed with breast cancer. I am putting an emphasis on holding insurance companies more accountable for minimum hospital stays for breast cancer treatment. I have sponsored a bill to require minimum stays for mastectomies, lumpectomies and lymph node dissections in the course of breast cancer treatment. It would also require coverage for secondary consultations. Unfortunately, many rural medical facilities aren’t equipped with the necessary mammogram systems. I have supported a bill to help address this need by expanding mobile mammography vehicle access, to help bring the necessary technologies and treatment to those that need it. This week, I proudly joined with my colleagues to support an appropriation for the Department of Defense Peer-Reviewed Breast Cancer Research Program. I also voted to expand and improve health care services from the Department of Veterans Affairs available to women veterans, especially those serving in Operation Enduring Freedom and Operation Iraqi Freedom. Our brave female service members deserve to have their needs taken into consideration when receiving medical treatment. Back in January, I sponsored a resolution recognizing the importance of cervical health and the early detection of cervical cancer. It was a resolution I was honored to sponsor. We are also working on diabetes research, treatment and education as well as fighting Sickle Cell Disease. I am a strong supporter and sponsor of H.R. 1032 which improves prevention, diagnosis and treatment of heart disease, stroke and other cardiovascular diseases in women. Heart disease is the number one killer of women in our country. It is vital that we continue to educate on ways to prevent heart disease in all of us. Health issues are of course not the only issues important to women. One of the first bills I voted for was the Lily Ledbetter Fair Pay Act. I was so proud to support this bill, which is designed to ensure equal pay for equal work. It overturned a 2007 Supreme Court decision that made it more difficult for women and others to pursue claims of pay discrimination. It is important to close the pay gap for women who work just as hard as their male counterparts. In November, I voted to modify the Small Business Act to improve women’s business centers. We need to continue encouraging female entrepreneurs, who are helping to create the small businesses which are driving our economic recovery. I have been blessed in many ways during my life. Not the least of which is the four amazing women who help shape my view of the world - my mother Virene, my wonderful wife Tina and my amazing daughters Jenny and Aspen. My 94-year-old mother is one of the strongest people I have ever met. She is a retired mathematics teacher and instilled in me a deep sense of community. She inspired me to pursue a career in teaching and helped give me the strength to run for Congress. My wife and daughters are my rock. These three generations of Kissell women amaze me every day. I hope you will take a moment this month to thank the women in your life for everything they do. Congressman Larry Kissell (D-N.C. -8) offices include Rockingham: 230 East Franklin St., Rockingham, NC 28379, Phone: 997-2070; Concord number (704) 786-1612; Fayetteville number (910) 920-2070; Washington office: 512 Cannon House Office Building, Washington, DC 20515; phone (202) 225-3715. Web site, kissell.house.gov. http://www.yourdailyjournal.com/view/full_story_home/6700436/article-A-celebration-of-women-in-the- 111th-Congress?instance=homesecondary_opinion_left_column -------- The Lymphedema Diagnosis and Treatment Cost Saving Act of 2010 was introduced in the US House of Representatives by my Congressman, Larry Kissell, on February 23rd and assigned the number HR 4662. To read the bill and related information you can visit the Library of Congress at http://thomas.loc.gov/; select search by bill number and enter HR 4662 in the box. Please help - It is time for you to do your part to ensure this act is passed into law! Contact your Representative and Senators and urge them to sign on as a primary or co-sponsor of this bill. The greater the number of sponsors the greater our chances will be at getting this bill passed. Elected officials are only accountable to their constituents, therefore only you have the power to persuade your members of Congress to support this bill. If passed, this act will ensure that we finally have nationwide, comprehensive lymphedema treatment coverage for all Americans who are insured – no matter what the cause of their lymphedema or whether they have Medicare or private insurance. Below is a sample letter you can use as is, but I hope that you will personalize yours, especially if you are a cancer survivor, have lymphedema, are a doctor or therapist. Please forward this information to others willing to support this effort. Feel free to contact me with questions – Heather Ferguson, hmff@earthlink. net. You may find your Congressional representatives by going to http://www.contactingthecongress.org and entering your address. If you are able to forward the National Lymphedema Network office (nln@lymphnet. org) the name and contact information of your representative they will also send a letter to him/her. If you are represented by Congressman Kissell - instead of sending the letter below please write to thank him for his sponsorship and reiterate the importance of this bill being passed into law. SEND EMAILS TO: Your Representative and Senators SUBJECT: Please (co)sponsor HR 4662, the Lymphedema Diagnosis & Treatment Cost Saving Act of 2010 EMAIL BODY: Dear (name of Representative/Senator you are sending to), I am writing to urge you to sign on as a primary or co-sponsor of the Lymphedema Diagnosis and Treatment Cost Saving Act of 2010, HR 4662, introduced by Congressman Larry Kissell on February 23, 2010. This act will reduce Medicare costs while improving patient care and quality of life. Currently Medicare and some private insurance companies do not offer complete coverage for this disease, which afflicts millions of Americans, and is most commonly caused by treatment for cancer. These policies only cover the expensive, difficult to treat and often chronic complications which are the inevitable result of patients having not received the proper medical care in the earlier stages. Such policies are falling short of providing these individuals treatment in accordance with established standards of care. And current policies lead to the expenditure of immense amounts of precious healthcare resources to treat preventable lymphedema-related cellulitis. Treatment for lymphedema is a medical necessity critical to the health and well-being of those who suffer from the disease. The clinically-proven treatment of lymphedema is called "complex decongestive therapy". It is used world-wide by the medical community, is not experimental and has decades of proven success. Unfortunately, not all components of this treatment fall under categories for which Medicare or private insurance companies typically provide coverage. With treatment, a patient lives a long, healthy and virtually normal life. But without treatment, the disease can grow progressively worse, causing severe disfigurement, disability and pain, and in some cases even results in death. A lymphedema treatment mandate went in to effect in North Carolina January 1, 2010, and one has been in effect in Virginia since 2004. This bill already has the official backing of the National Lymphedema Network and Susan G. Komen for the Cure, and the endorsement of other national groups is anticipated. For additional information or to (co) sponsor this bill, contact Zach Pfister in Congressman Kissell’s office at zach.pfister@mail.house.gov or 202-225-3715. Please support the Lymphedema Diagnosis and Treatment Cost Saving Act of 2010, which will improve patient care while reducing Medicare costs, by signing on as a primary or co-sponsor of this bill. Sincerely, Your Name Your Address (required) ----- EXECUTIVE DIRECTOR Saskia R.J. Thiadens, RN BOARD OF DIRECTORS Wade Farrow, MD, CWS, FCCWS Dave W. Lob, MBA Tess Karwoski, RN Max Salas, MBA Saskia R.J. Thiadens, RN MEDICAL ADVISORY COMMITTEE Jane M. Armer, RN, PhD Marcia Beck, APRN, BC, CLT-LANA Andrea L. Cheville, MD Janice N. Cormier, MD, MPH Joseph L. Feldman, MD, CLT-LANA Kathleen Francis, MD Mei R. Fu, PhD, MS, MA, RN, APRN-BC Nancy Hutchison, MD Bonnie B. Lasinski, MA, PT, CLT-LANA Ruth Moseley, MS, PT, CLT-LANA Sheila H. Ridner, MSN, PhD, RN Paula J. Stewart, MD, CLT-LANA Saskia R.J. Thiadens, RN Kathryn McKillip Thrift, BS, CLT-LANA Catherine M. Tuppo, MS, PT, CLT-LANA INTERNATIONAL ADVISORY COMMITTEE Judith Casley-Smith, PhD Lymphoëdema Association of Australia Dr. med Ételka Földi Földi-Klinik, Germany Prof. Dr. med Michael Földi Földi-Klinik, Germany Waldermar L. Olszewski, MD Polish Academy of Sciences, Poland Marlys H. Witte, MD University of Arizona Medical Center, Tucson National Lymphedema Network, Inc. 116 New Montgomery Street, Suite 235 San Francisco, CA 94105 Tel: (415) 908-3681 Fax: (415) 908-3813 Infoline: 800-541-3259 Email: nln@lymphnet.org Website: www.lymphnet.org The NLN is a 501©(3) Non-profit organization Honorable Senator/Congressmember [Name of your legislator] The National Lymphedema Network urges you to move H.R. 4662 the Lymphedema Diagnosis and Treatment Cost-Saving Act of 2010 [Kissell NC] to the House with a favorable recommendation this session. LYMPHEDEMA is a medical condition affecting an estimated 1.5 to 3 million Medicare Beneficiaries who are not currently receiving treatment from Medicare according to the current medical standard of care. But what is worse is that Medicare is spending billions of dollars every year treating largely preventable lymphedema-related CELLULITIS. There is no conflict with current Congressional efforts to pass a Medicare access bill since this is a quality of care bill. The bill also does not conflict with any CMS policies, but instead it removes ambiguities and clarifies coverage issues. LYMPHEDEMA is a condition caused by injury, trauma or congenital defects involving the lymph system. The primary function of the lymphatic system is to cleanse the body of toxins and defend against infection. Primary Lymphedema is congenital. Secondary Lymphedema can be caused by surgeries or radiation treatments and is a common side effect of cancer treatments that remove or damage lymph nodes. Lymphedema results in the chronic swelling of a body area or part nearest the damaged portion of the lymph system, commonly an arm or leg, but the chest, neck and trunk can also be affected. Lymphedema is incurable and progressive, and if left untreated, the swollen area can become fibrous and prone to serious, debilitating infections. Over time, untreated lymphedema results in disfigurement, disability and even death. The recognized standard of treatment of lymphedema is Complete Decongestive Therapy (CDT). CDT comprises four interacting protocols applied in two phases (acute and ongoing): manual lymph drainage (MLD); compression therapy; lymph drainage exercises; and skin care. [Refs: ACS 1998, ISL 2003, NLN 2006]. The initial intensive phase is performed by medical professionals, but ongoing care is patient self- provided using techniques taught the patient by the healthcare provider. Medicare does not cover lymphedema treatment materials or treatment by lymphedema- qualified professionals other than Physical Therapists and Occupational Therapists, nor does Medicare require that the provider of lymphedema treatment services be qualified in the specialized techniques. While Medicare does cover and pay for statutorily-limited therapy and sequential compression pumps, many patients suffer recurrent infections, progressive degradation in their condition and eventual disability because they cannot afford the compression bandages and garments required for their everyday self-care. Denials of coverage for lymphedema compression bandage systems, compression garments and devices and supplies are based on inconsistent interpretations of Federal statutes and the Medicare publication system, and CMS has stated repeatedly that a change in the law will be necessary in order for them to change their policies to cover these medically necessary items. This bill will accomplish the required change. Please understand that this is NOT a new health mandate. The staff, equipment and facilities are already in place in most medical providers. Most providers already cover lymphedema treatment, and there are no exclusions in any medical policies that we are aware of. The Women’s Health and Cancer Rights Act of 1998 already mandates the treatment of lymphedema resulting from breast cancer treatment. This bill would extend that care to Medicare beneficiaries for all causes of lymphedema. It can be shown to result in medical savings which exceed ongoing costs by factors of 2-5. A lymphedema coverage mandate has been in effect in Virginia since 2004, and a similar law was passed in North Carolina this year, to become effective in 2010. Data from the first five years of operation in Virginia show claim costs of $1.12-2.82 per year per contract (0.04-0.09% of total claims) not accounting for the savings due to reduced cellulitis rates. We urge you to move H.R. 4662 Kissell which has the backing of the National Lymphedema Network. Contact us with any questions or with requests for further information, medical evidence, cost efficacy data or any other questions. Sincerely yours, Saskia R.J. Thiadens R.N. Executive Director, NLN ------ HOUSE Medical Doctors Family medicine Vic Snyder – Katie.Hargis@mail.house.gov Arkansas-2nd, Democrat 2210 Rayburn HOB Washington, DC 20515-0402 Phone: (202) 225-2506 / fax 225-5903 John C. Fleming – Michelle.Kirtley@mail.house.gov Louisiana-4th, Republican 1023 Longworth HOB Washington, DC 20515-1804 Phone: (202) 225-2777 / fax - 225-8039 Paul Broun – Joe.Murray@mail.house.gov Georgia-10th, Republican 325 Cannon HOB Washington, DC 20515-1009 Phone: (202) 225-4101 / fax 226-0776 Delegate Donna Christensen Virgin Islands-Delegate, Democrat 1510 Longworth HOB Washington, DC 20515-5501 Phone: (202) 225-1790 / Fax: 202-225-5517 Dir. of Health Policy Britt Weinstock: britt.weinstock@mail.house.gov Psychiatrist Jim McDermott – Tiana.Korley@mail.house.gov Washington-7th, Democrat 1035 Longworth HOB Washington, DC 20515-4707 Phone: (202) 225-3106 / Fax: 202-225-6197 Ob/gyns Michael C. Burgess Texas-26th, Republican 229 Cannon HOB Washington, DC 20515-4326 Phone: (202) 225-7772, Fax: 202-225-2919 Heath aide - James Paluskiewicz: james.paluskiewicz@mail.house.gov Ron Paul – already a co-sponsor! Phil Roe– already a co-sponsor! Phil Gingrey Georgia-11th, Republican 119 Cannon HOB Washington, DC 20515-1011 Phone: (202) 225-2931 / Fax: 202-225-2944 Heath aide - Robert Horne: robert.horne@mail.house.gov Allergist Steve Kagen - Norah.Spooner@mail.house.gov Wisconsin-8th, Democrat 1232 Longworth HOB Washington, DC 20515-4908 Phone: (202) 225-5665 / fax 225-5729 Heart surgeon Charles Boustany Louisiana-7th, Republican 1117 Longworth HOB Washington, DC 20515-1807 Phone: (202) 225-2031 / Fax: 202-225-5724 Heath aide - Mike Thompson: mike.thompson@mail.house.gov Radiation oncologist Parker Griffith Alabama-5th, Republican 417 Cannon HOB Washington, DC 20515-0105 Phone: (202) 225-4801 / Fax: 202-225-4392 Marcus Huskey: marcus.huskey@mail.house.gov Orthopedic surgeons Tom Price – Emily.Murry@mail.house.gov Georgia-6th, Republican 424 Cannon HOB Washington, DC 20515-1006 Phone: (202) 225-4501 / fax 225-4656 Hematologist/gastroenterologist Bill Cassidy – Aimee.Hartlage@mail.house.gov Louisiana-6th, Republican 506 Cannon HOB Washington, DC 20515-1806 Phone: (202) 225-3901 / fax 225-7313 Nurses Carolyn McCarthy New York-4th, Democrat 2346 Rayburn HOB Washington, DC 20515-3204 Phone: (202) 225-5516 / fax 225-5758 Lois Capps California-23rd, Democrat 1110 Longworth HOB Washington, DC 20515-0523 Phone: (202) 225-3601 / Fax: 202-225-5632 Heath aide - Amy Fisher: amy.fisher@mail.house.gov Eddie Bernice Johnson Texas-30th, Democrat 1511 Longworth HOB Washington, DC 20515-4330 Phone: (202) 225-8885 / fax 226-1477 Scientists Physicists Rush Holt – Rob Saunders - Rob.Saunders@mail.house.gov New Jersey-12th, Democrat 1214 Longworth HOB Washington, DC 20515-3012 Phone: (202) 225-5801 / fax 225-6025 Bill Foster – Sandy.Sussman@mail.house.gov Illinois-14th, Democrat 1339 Longworth HOB Washington, DC 20515-1314 Phone: (202) 225-2976 / fax 225-0697 Vern Ehlers – Rachel.Fenton@mail.house.gov Michigan-3rd, Republican 2182 Rayburn HOB Washington, DC 20515-2203 Phone: (202) 225-3831 / fax 225-5144 Chemist Ed Pastor – Karen Foster Wright (did not clarify email address – sorry) Arizona-4th, Democrat 2465 Rayburn HOB Washington, DC 20515-0304 Phone: (202) 225-4065 / fax 225-1655 Microbiologist Rep. Louise Slaughter –Sarah Norman (sarah@mail.house.gov) - (This is what they said the address was, but it is strange not to use the last name) or Sarah.Norman@mail.house.gov New York-28th, Democrat 2469 Rayburn HOB Washington, DC 20515-3228 Phone: (202) 225-3615 / Fax: 202-225-7822 Physiologist Roscoe Bartlett – Faye Powers - faye.powers@mail.house.gov Maryland-6th, Republican 2412 Rayburn HOB Washington, DC 20515-2006 Phone: (202) 225-2721 / fax 225-2193 SENATE Ob/gyns Tom Coburn – Josh_Trent@Coburn.Senate.gov (R - OK) Class III 172 RUSSELL SENATE OFFICE BUILDING WASHINGTON DC 20510 (202) 224-5754 / fax 224-6008 Orthopedic surgeons John Barrasso - Erin_Dempsey@Barrasso.Senate.gov (R - WY) Class I 307 DIRKSEN SENATE OFFICE BUILDING WASHINGTON DC 20510 (202) 224-6441 / fax 224-1724 ----- ENERGY AND COMMERCE Henry A. Waxman, CA, Chairman – Phone: (202) 225-3976, Fax: 202-225-4099, 2204 Rayburn HOB Washington, DC 20515-0530 waxman.staff@mail.house.gov John D. Dingell, MI, Chairman Emeritus - Phone: (202) 225-4071, Fax: 202-226-0371 2328 Rayburn HOB Washington, DC 20515-2215 public.dingell@mail.house.gov HEALTH Frank Pallone, Jr., NJ, Chairman - Phone: (202) 225-4671, Fax: 202-225-9665 237 Cannon HOB Washington, DC 20515-3006 Heath aide - Tiffany Guarascio: tiffany.guarascio@mail.house.gov John D. Dingell, MI - Phone: (202) 225-4071, Fax: 202-226-0371 237 Cannon HOB Washington, DC 20515-3006 public.dingell@mail.house.gov Bart Gordon, TN - Phone: (202) 225-4231, Fax: 202-225-6887 2306 Rayburn HOB Washington, DC 20515-4206 bart.gordon@mail.house.gov Anna G. Eshoo, CA - Phone: (202) 225-8104, Fax: 202-225-8890 205 Cannon HOB Washington, DC 20515-0514 annagram@mail.house.gov Heath aide - Erin Katzelnick-Wise: erin.katzelnick-wise@mail.house.gov Eliot L. Engel, NY - Phone: (202) 225-2464, Fax: 202-225-5513 2161 Rayburn HOB Washington, DC 20515-3217 conduit name is Emily Gibbons: emily.gibbons@mail.house.gov Gene Green, TX - Phone: (202) 225-1688, Fax: 202-225-9903 2372 Rayburn HOB Washington, DC 20515-4329 Heath aide - Abigail Pinkele: abigail.pinkele@mail.house.gov Diana DeGette, CO - Phone: (202) 225-4431, Fax: 202-225-5657 2335 Rayburn HOB Washington, DC 20515-0601 degette@mail.house.gov Heath aide - Heather Foster: heather.foster@mail.house.gov Lois Capps, CA, Vice Chair - Phone: (202) 225-3601, Fax: 202-225-5632 1110 Longworth HOB Washington, DC 20515-0523 Heath aide - Amy Fisher: amy.fisher@mail.house.gov Janice D. Schakowsky, IL - Phone: (202) 225-2111, Fax: 202-226-6890 2367 Rayburn HOB Washington, DC 20515-1309 jan.schakowsky@mail.house.gov Heath aide - Rebecca Mark: Rebecca.mark@mail.house.gov Tammy Baldwin, WI - Phone: (202) 225-2906, Fax: 202-225-6942 2446 Rayburn HOB Washington, DC 20515-4902 tammy.baldwin@mail.house.gov Heath aide - Elizabeth Lee: Elizabeth.lee@mail.house.gov Mike Ross, AR - Phone: (202) 225-3772, Fax: 202-225-1314 2436 Rayburn HOB Washington, DC 20515-0404 Heath aide - Kate Callanan: kate.callanan@mail.house.gov Anthony D. Weiner, NY - Phone: (202) 225-6616, Fax: 202-226-7243 2104 Rayburn HOB Washington, DC 20515-3209 weiner@mail.house.gov Heath aide - Joe Dunn: joe.dunn@mail.house.gov Jim Matheson, UT - Phone: (202) 225-3011, Fax: 202-225-5638 2434 Rayburn HOB Washington, DC 20515-4402 jim.matheson@mail.house Heath aide - Shana Beavin: shana.beavin@mail.house.gov Jane Harman, CA - Phone: (202) 225-8220, Fax: 202-226-7290 2400 Rayburn HOB Washington, DC 20515-0536 jane.harman@mail.house.gov Heath aide - Isidro Panuco: isidro.panuco@mail.house.gov Charles A. Gonzalez, TX - Phone: (202) 225-3236, Fax: 202-225-1915 303 Cannon HOB Washington, DC 20515-4320 Heath aide - Julie Hart: Julie.hart@mail.house.gov John Barrow, GA - Phone: (202) 225-2823, Fax: 202-225-3377 213 Cannon HOB Washington, DC 20515-1012 Heath aide - Hill Thomas: hill.thomas@mail.house.gov Donna M. Christensen, VI - Phone: (202) 225-1790, Fax: 202-225-5517 1510 Longworth HOB Washington, DC 20515-5501 donna.christensen@mail.house.gov Dir. of Health Policy Britt Weinstock: britt.weinstock@mail.house.gov Kathy Castor, FL - Phone: (202) 225-3376, Fax: 202-225-5652 317 Cannon HOB Washington, DC 20515-0911 Heath aide - Jocelyn Reid: Jocelyn.reid@mail.house.gov John P. Sarbanes, MD - Phone: (202) 225-4016, Fax: 202-225-9219 426 Cannon HOB Washington, DC 20515-2003 Heath aide - Dvora Lovinger: dvora.lovinger@mail.house.gov Christopher S. Murphy, CT - Phone: (202) 225-4476, Fax: 202-225-4488 412 Cannon HOB Washington, DC 20515-0705 Jesse Young (Energy and Commerce staffer): jesse.young@mail.house.gov Heath aide - Paul Kidwell (Health Staffer): paul.kidwell@mail.house.gov Zachary T. Space, OH - Phone: (202) 225-6265, Fax: 202-225-3394 315 Cannon HOB Washington, DC 20515-3518 Betty Sutton, OH - Phone: (202) 225-3401, Fax: 202-225-2266 1721 Longworth HOB Washington, DC 20515-3513 Heath aide - Carla McNeill: carla.mcneill@mail.house.gov Bruce L. Braley, IA - Phone: (202) 225-2911, Fax: 202-225-9129 1019 Longworth HOB Washington, DC 20515-1501 Heath aide - Mike Goodman: mike.goodman@mail.house.gov Henry A. Waxman, CA, Ex Officio - Phone: (202) 225-3976, Fax: 202-225-4099 2204 Rayburn HOB Washington, DC 20515-0530 waxman.staff@mail.house.gov Nathan Deal, GA - Phone: (202) 225-5211, Fax: 202-225-5995 2133 Rayburn HOB Washington, DC 20515-1010 Heath aide - Blake Fulenwider: blake.fulenwider@mail.house.gov Ralph M. Hall, TX – Phone: (202) 225-6673, Fax: 202-225-3332 2405 Rayburn HOB Washington, DC 20515-4304 rmhall@mail.house.gov Heath aide - Kyle Oliver: kyle.oliver@mail.house.gov Ed Whitfield, KY - Phone: (202) 225-3115, Fax: 202-225-3547 2411 Rayburn HOB Washington, DC 20515-1701 Heath aide - Jeff Mortier: jeff.mortier@mail.house.gov John Shimkus, IL - Phone: (202) 225-5271, Fax: 202-225-5880 2452 Rayburn HOB Washington, DC 20515-1319 Heath aide - Chris Sarley: chris.sarley@mail.house.gov John B. Shadegg, AZ - Phone: (202) 225-3361, Fax: 202-225-3462 436 Cannon HOB Washington, DC 20515-0303 j.shadegg@mail.house.gov Heath aide - Paul Edattel: paul.edattel@mail.house.gov Roy Blunt, MO - Phone: (202) 225-6536, Fax: 202-225-5604 2229 Rayburn HOB Washington, DC 20515-2507 blunt@mail.house.gov Heath aide - Kristina Weger: Kristina.weger@mail.house.gov Steve Buyer, IN - Phone: (202) 225-5037, Fax: 202-225-2267 2230 Rayburn HOB Washington, DC 20515-1404 Heath aide - Allison Hite: allison.hite@mail.house.gov Joseph R. Pitts, PA - Phone: (202) 225-2411, Fax: 202-225-2013 420 Cannon HOB Washington, DC 20515-3816 Heath aide - Monica Volante: monica.volante@mail.house.gov Mike Rogers, MI - Phone: (202) 225-3261, Fax: 202-225-5820 133 Cannon HOB Washington, DC 20515-2208 Sue Wilkins Myrick, NC - Phone: (202) 225-1976, Fax: 202-225-3389 230 Cannon HOB Washington, DC 20515-3309 sue@suemyrick.com Heath aide - Sarah Hale: Sarah.Hale@mail.house.gov, Scheduler: heather.whillier@mail.house.gov Tim Murphy, PA - Phone: (202) 225-2301, Fax: 202-225-1844 322 Cannon HOB Washington, DC 20515-3818 Heath aide - Brad Grantz: brad.grantz@mail.house.gov Michael C. Burgess, TX - Phone: (202) 225-7772, Fax: 202-225-2919 229 Cannon HOB Washington, DC 20515-4326 Heath aide - James Paluskiewicz: james.paluskiewicz@mail.house.gov Marsha Blackburn, TN - Phone: (202) 225-2811, Fax: 202-225-3004 217 Cannon HOB Washington, DC 20515-4207 Heath aide - Cara Dalmolin: cara.dalmolin@mail.house.gov Phil Gingrey, GA - Phone: (202) 225-2931, Fax: 202-225-2944 119 Cannon HOB Washington, DC 20515-1011 gingrey.ga@mail.house.gov Heath aide - Robert Horne: robert.horne@mail.house.gov Joe Barton, TX, Ex Officio – Phone: (202) 225-2002, Fax: 202-225-3052 2109 Rayburn HOB Washington, DC 20515-4306 Heath aide - Noel Bryant: noel.bryant@mail.house.gov WAYS AND MEANS Charles B. Rangel, NY, Chairman - Phone: (202) 225-4365, Fax: 202-226-0816 2354 Rayburn HOB Washington, DC 20515-3215 Heath aide - Jon Sheiner: jon.sheiner@mail.house.gov HEALTH Fortney Pete Stark, CA, Chairman - Phone: (202) 225-5065, Fax: 202-226-3805 239 Cannon HOB Washington, DC 20515-0513 petemail@stark.house.gov Heath aide - Debra Curtis: debra.curtis@mail.house.gov Lloyd Doggett, TX - Phone: (202) 225-4865, Fax: 202-225-2947 201 Cannon HOB Washington, DC 20515-4325 Heath aide - Michealle Carpenter: michealle.carpenter@mail.house.gov Mike Thompson, CA - Phone: (202) 225-4865, Fax: 202-225-2947 231 Cannon HOB Washington, DC 20515-0501 Heath aide - Elizabeth Ziegler: elizabeth.ziegler@mail.house.gov Xavier Becerra, CA - Phone: (202) 225-6235, Fax: 202-225-2202 1119 Longworth HOB Washington, DC 20515-0531 Heath aide - Sean McCluskie: sean.mccluskie@mail.house.gov Earl Pomeroy, ND - Phone: (202) 225-2611, Fax: 202-226-0893 1501 Longworth HOB Washington, DC 20515-3401 rep.earl.pomeroy@mail.house.gov Ron Kind, WI - Phone: (202) 225-5506, Fax: 202-225-5739 1406 Longworth HOB Washington, DC 20515-4903 Heath aide - Travis Robey: travis.robey@mail.house.gov Earl Blumenauer, OR - Phone: (202) 225-4811, Fax: 202-225-8941 2267 Rayburn HOB Washington, DC 20515-3703 Heath aide - Christa Shively: christa.shively@mail.house.gov Bill Pascrell, Jr., NJ - Phone: (202) 225-5751, Fax: 202-225-5751 2464 Rayburn HOB Washington, DC 20515-3008 Heath aide - Mandy Spears: mandy.spears@mail.house.gov Shelley Berkley, NV - Phone: (202) 225-5965, Fax: 202-225-3119 405 Cannon HOB Washington, DC 20515-2801 shelley.berkley@mail.house.gov Heath aide - Carrie Fiarman: carrie.fiarman@mail.house.gov Wally Herger, CA - Phone: (202) 225-3076, Fax: 202-225-1740 242 Cannon HOB Washington, DC 20515-0502 Heath aide - Jay Fulzsmann: Jay.Fulzmann@mail.house.gov Sam Johnson, TX - Phone: (202) 225-4201, Fax: 202-225-1485 1211 Longworth HOB Washington, DC 20515-4303 Heath aide - Jeni Healy: jenifer.healy@mail.house.gov Paul Ryan, WI - Phone: (202) 225-3031, Fax: 202-225-3393 1113 Longworth HOB Washington, DC 20515-4901 Heath aide - Matt Hoffmann: matt.hoffmann@mail.house.gov Devin Nunes, CA - Phone: (202) 225-2523, Fax: 202-225-3404 1013 Longworth HOB Washington, DC 20515-0521 Heath aide - Andrew House Andrew.house@mail.house.gov Ginny Brown-Waite, FL - Phone: (202) 225-1002, Fax: 202-226-6559 414 Cannon HOB Washington, DC 20515-0905 Heath aide - Justin Graybelle: justin.graybelle@mail.house.gov. The Lymphedema Diagnosis and Treatment Cost Saving Act of 2010 has been introduced in the US House of Representatives by my Congressman, Larry Kissell, and assigned the number HR 4662. To read the bill and related information you can visit the Library of Congress at http://thomas.loc.gov/; select search by bill number and enter HR 4662 in the box. Please do your part to ensure this act is passed into law! Contact your Representative and Senators and urge them to sign on as a primary or co-sponsor of this bill. The greater the number of sponsors the greater our chances will be at getting this bill passed. Elected officials are only accountable to their constituents, therefore only you have the power to persuade your members of Congress to support this bill. If passed, this act will ensure that we finally have nationwide, comprehensive lymphedema treatment coverage for all Americans who are insured – no matter what the cause of their lymphedema or whether they have Medicare or private insurance. Below are sample letters you can use as is, but I hope that you will personalize yours, especially if you are a cancer survivor, have lymphedema, are a doctor or therapist. Please forward this information to others willing to support this effort. Feel free to contact me with questions – Heather Ferguson, hmff@earthlink.net. You may find your Congressional representatives by going to http://www.contactingthecongress.org and entering your address. If you are able to forward the National Lymphedema Network office (nln@lymphnet. org) the name and contact information of your representative they will also send a letter to him/her. If you are represented by Congressman Kissell - instead of sending the letter below please write to thank him for his sponsorship and reiterate the importance of this bill being passed into law. EMAIL TO: Your Representative SUBJECT: Please (co)sponsor HR 4662, the Lymphedema Diagnosis & Treatment Cost Saving Act of 2010 EMAIL BODY: Dear (name of Representative), I am writing to urge you to sign on as a primary or co-sponsor of the Lymphedema Diagnosis and Treatment Cost Saving Act of 2010, HR 4662, introduced by Congressman Larry Kissell on February 23, 2010. This act will reduce Medicare costs while improving patient care and quality of life. Currently Medicare and some private insurance companies do not offer complete coverage for this disease, which afflicts millions of Americans, and is most commonly caused by treatment for cancer, with breast cancer being by far the most prevalent cause. These policies only cover the expensive, difficult to treat and often chronic complications which are the inevitable result of patients having not received the proper medical care in the earlier stages. Such policies are falling short of providing these individuals treatment in accordance with established standards of care. And current policies lead to the expenditure of immense amounts of precious healthcare resources to treat preventable lymphedema-related cellulitis. Treatment for lymphedema is a medical necessity critical to the health and well-being of those who suffer from the disease. The clinically-proven treatment of lymphedema is called "complex/complete decongestive therapy". It is used world-wide by the medical community, is not experimental and has decades of proven success. Unfortunately, not all components of this treatment fall under categories for which Medicare or private insurance companies typically provide coverage. With treatment, a patient lives a long, healthy and virtually normal life. But without treatment, the disease can grow progressively worse, causing severe disfigurement, disability and pain, and in some cases even results in death. A lymphedema treatment mandate went in to effect in North Carolina January 1, 2010, and one has been in effect in Virginia since 2004. This bill already has the official backing of the National Lymphedema Network and the endorsement of other national groups is anticipated. For additional information or to (co)sponsor this bill, contact Zach Pfister in Congressman Kissell’s office at zach.pfister@mail.house.gov or 202-225-3715. Please support the Lymphedema Diagnosis and Treatment Cost Saving Act of 2010, which will improve patient care while reducing Medicare costs, by signing on as a primary or co-sponsor of this bill. Sincerely, Your Name Your Address (required) EMAIL TO: Both of your Senators SUBJECT: Please Sponsor HR 4662, the Lymphedema Diagnosis & Treatment Cost Saving Act of 2010 EMAIL BODY: Dear (name of Senator), The Lymphedema Diagnosis and Treatment Cost Saving Act of 2010, HR 4662, was introduced by Congressman Larry Kissell on February 23, 2010. I am writing to urge you to sponsor companion legislation in the Senate. This act will reduce Medicare costs while improving patient care and quality of life. Currently Medicare and some private insurance companies do not offer complete coverage for this disease, which afflicts millions of Americans, and is most commonly caused by treatment for cancer, with breast cancer being by far the most prevalent cause. These policies only cover the expensive, difficult to treat and often chronic complications which are the inevitable result of patients having not received the proper medical care in the earlier stages. Such policies are falling short of providing these individuals treatment in accordance with established standards of care. And current policies lead to the expenditure of immense amounts of precious healthcare resources to treat preventable lymphedema-related cellulitis. Treatment for lymphedema is a medical necessity critical to the health and well-being of those who suffer from the disease. The clinically-proven treatment of lymphedema is called "complex/complete decongestive therapy". It is used world-wide by the medical community, is not experimental and has decades of proven success. Unfortunately, not all components of this treatment fall under categories for which Medicare or private insurance companies typically provide coverage. With treatment, a patient lives a long, healthy and virtually normal life. But without treatment, the disease can grow progressively worse, causing severe disfigurement, disability and pain, and in some cases even results in death. A lymphedema treatment mandate went in to effect in North Carolina January 1, 2010, and one has been in effect in Virginia since 2004. This bill already has the official backing of the National Lymphedema Network and the endorsement of other national groups is anticipated. For additional information or to (co)sponsor this bill, contact Zach Pfister in Congressman Kissell’s office at zach.pfister@mail.house.gov or 202-225-3715. Please support the Lymphedema Diagnosis and Treatment Cost Saving Act of 2010, which will improve patient care while reducing Medicare costs, by signing on as a primary or co-sponsor of this bill. Sincerely, Your Name Your Address (required) --------- (Date) Dear (name of Representative/Senator you are sending to), I am writing to urge you to sign on as a primary or co-sponsor of the Lymphedema Diagnosis and Treatment Cost Saving Act of 2010, HR 4662, introduced by Congressman Larry Kissell on February 23, 2010. This act will reduce Medicare costs while improving patient care and quality of life. Currently Medicare and some private insurance companies do not offer complete coverage for this disease, which afflicts millions of Americans, and is most commonly caused by treatment for cancer. These policies only cover the expensive, difficult to treat and often chronic complications which are the inevitable result of patients having not received the proper medical care in the earlier stages. Such policies are falling short of providing these individuals treatment in accordance with established standards of care. And current policies lead to the expenditure of immense amounts of precious healthcare resources to treat preventable lymphedema-related cellulitis. Treatment for lymphedema is a medical necessity critical to the health and well-being of those who suffer from the disease. The clinically-proven treatment of lymphedema is called "complex decongestive therapy". It is used world-wide by the medical community, is not experimental and has decades of proven success. Unfortunately, not all components of this treatment fall under categories for which Medicare or private insurance companies typically provide coverage. With treatment, a patient lives a long, healthy and virtually normal life. But without treatment, the disease can grow progressively worse, causing severe disfigurement, disability and pain, and in some cases even results in death. A lymphedema treatment mandate went in to effect in North Carolina January 1, 2010, and one has been in effect in Virginia since 2004. This bill already has the official backing of the National Lymphedema Network and Susan G. Komen for the Cure, and the endorsement of other national groups is anticipated. For additional information or to (co) sponsor this bill, contact Zach Pfister in Congressman Kissell’s office at zach.pfister@mail.house.gov or 202-225-3715. Please support the Lymphedema Diagnosis and Treatment Cost Saving Act of 2010, which will improve patient care while reducing Medicare costs, by signing on as a primary or co-sponsor of this bill. Sincerely, (Your name) (Your address – REQUIRED) |