Lymphedema Treatment Act Explained

*Disclaimer: This page is a guide to information on the Lymphedema Treatment Act and what it can mean for those diagnosed with either Lipedema or Lymphedema. It is not to be misinterpreted for legal, insurance, or medical advice. You should always consult your physician to discuss proper treatment for your condition.

What is the Lymphedema Treatment Act?

The Lymphedema Treatment Act is a federal law passed on 12/23/22 and effective from 1/1/24.

It addresses the lack of insurance coverage for crucial compression supplies needed for lymphedema treatment. Medicare and many other policies didn't cover these supplies, leading to significant challenges for patients. The Lymphedema Treatment Act aims to amend Medicare statute to include coverage for compression supplies, potentially setting a precedent for Medicaid and private insurers.

While the Lymphedema Treatment Act directly impacts Medicare, it could indirectly benefit all patients as most insurance plans follow Medicare guidelines. This legislation was necessary because compression supplies couldn't be classified under existing Medicare benefit categories. Although the Lymphedema Treatment Act focuses on Medicare, its impact extends to other insurance plans.

Why was the Lymphedema Treatment Act Needed?

Before January 1, 2024, medicare, and many other insurance policies, did not cover a critical component of lymphedema treatment: doctor-prescribed compression supplies. These supplies are essential for daily use in managing lymphedema and lipedema. Without coverage, many patients cannot afford these necessary supplies, leading to recurrent infections, worsening conditions, and eventual disability.

Until this act was passed, Medicare didn’t cover compression supplies because they didn’t fit into any existing Medicare benefit category. Compression supplies have a lifespan of about six months, so they didn’t qualify as Durable Medical Equipment, nor are they disposable single-use products or classified as orthotics or prosthetics.

The Center for Medicare Services (CMS) lacks the authority to create or redefine benefit categories; only Congress can do that. This necessity for legislative action is detailed in correspondence between former Congressman Dave Reichert and former Health and Human Services Secretary Kathleen Sebelius.

The Lymphedema Treatment Act was first introduced in Congress in 2010 by Representative Larry Kissell. Each successive Congress has shown increasing support for the bill with the bill finally passing as part of the Consolidated Appropriations Act of 2023. The text of our bill that was included in that package was identical to the version that was passed by the House as a stand alone bill on November 17, 2022.

Why was the Lymphedema Treatment Act Needed?

The Lymphedema Treatment Act established a new Medicare benefit category specifically for lymphedema compression supplies. The reason Medicare couldn't cover these supplies was because they didn't fit into any existing benefit categories.

Since only Congress has the authority to create new Medicare benefit categories, legislation was necessary to address this gap.

All other aspects of lymphedema treatment are covered under existing benefit categories and couldn't be included in the Lymphedema Treatment Act.

While the Lymphedema Treatment Act directly mandates Medicare coverage, its indirect impact benefits all patients, as most other insurance plans follow Medicare guidelines.

Over the 12 years it took to pass the Lymphedema Treatment Act, private insurance plans increasingly aligned their coverage with Medicare's, citing it as the reason for changes. This shift, previously detrimental, now works to the benefit of patients.

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