Lymphedema Treatment Act
Floor Speech
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Mr. PALLONE. Mr. Speaker, I move to suspend the rules and pass the bill (H.R. 3630) to amend title XVIII of the Social Security Act to provide for coverage of certain lymphedema compression treatment items under the Medicare program, as amended.
The Clerk read the title of the bill.
The text of the bill is as follows: H.R. 3630
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. MEDICARE COVERAGE OF CERTAIN LYMPHEDEMA COMPRESSION TREATMENT ITEMS.
(a) Coverage.--
(1) In general.--Section 1861 of the Social Security Act (42 U.S.C. 1395x) is amended--
(A) in subsection (s)(2)--
(i) in subparagraph (GG), by striking ``and'' after the semicolon at the end;
(ii) in subparagraph (HH), by striking the period at the end and inserting ``; and''; and
(iii) by adding at the end the following new subparagraph:
``(II) lymphedema compression treatment items (as defined in subsection (lll));''; and
(B) by adding at the end the following new subsection:
``(lll) Lymphedema Compression Treatment Items.--The term `lymphedema compression treatment items' means standard and custom fitted gradient compression garments and other items determined by the Secretary that are--
``(1) furnished on or after January 1, 2024, to an individual with a diagnosis of lymphedema for the treatment of such condition;
``(2) primarily and customarily used to serve a medical purpose and for the treatment of lymphedema, as determined by the Secretary; and
``(3) 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).''.
(2) Payment.--
(A) In general.--Section 1833(a)(1) of the Social Security Act (42 U.S.C. 1395l(a)(1)) is amended--
(i) by striking ``, and'' before ``(EE)''; and
(ii) by inserting before the semicolon at the end the following: ``, and (FF) with respect to lymphedema compression treatment items (as defined in section 1861(lll)), the amount paid shall be equal to 80 percent of the lesser of the actual charge or the amount determined under the payment basis determined under section 1834(z)''.
(B) Payment basis and limitations.--Section 1834 of the Social Security Act (42 U.S.C. 1395m) is amended by adding at the end the following new subsection:
``(z) Payment for Lymphedema Compression Treatment Items.--
``(1) In general.--The Secretary shall determine an appropriate payment basis for lymphedema compression treatment items (as defined in section 1861(lll)). In making such a determination, the Secretary may take into account payment rates for such items under State plans (or waivers of such plans) under title XIX, the Veterans Health Administration, and group health plans and health insurance coverage (as such terms are defined in section 2791 of the Public Health Service Act), and such other information as the Secretary determines appropriate.
``(2) Frequency limitation.--No payment may be made under this part for lymphedema compression treatment items furnished other than at such frequency as the Secretary may establish.
``(3) Application of competitive acquisition.--In the case of lymphedema compression treatment items that are included in a competitive acquisition program in a competitive acquisition area under section 1847(a)--
``(A) the payment basis under this subsection for such items furnished in such area shall be the payment basis determined under such competitive acquisition program; and
``(B) the Secretary may use information on the payment determined under such competitive acquisition programs to adjust the payment amount otherwise determined under this subsection for an area that is not a competitive acquisition area under section 1847, and in the case of such adjustment, paragraphs (8) and (9) of section 1842(b) shall not be applied.''.
(3) Conforming amendment.--Section 1847(a)(2) of the Social Security Act (42 U.S.C. 1395w-3(a)(2)) is amended by adding at the end the following new subparagraph:
``(D) Lymphedema compression treatment items.--Lymphedema compression treatment items (as defined in section 1861(lll)) for which payment would otherwise be made under section 1834(z).''.
(b) Inclusion in Requirements for Suppliers of Medical Equipment and Supplies.--Section 1834 of the Social Security Act (42 U.S.C. 1395m) is amended--
(1) in subsection (a)(20)(D), by adding at the end the following new clause:
``(iv) Lymphedema compression treatment items (as defined in section 1861(lll)).''.
(2) in subsection (j)(5)--
(A) by redesignating subparagraphs (E) and (F) as subparagraphs (F) and (G), respectively; and
(B) by inserting after subparagraph (D) the following new subparagraph:
``(E) lymphedema compression treatment items (as defined in section 1861(lll));''. SEC. 3. MEDICARE IMPROVEMENT FUND.
Section 1898(b)(1) of the Social Security Act (42 U.S.C. 1395iii(b)(1)) is amended by striking ``$7,308,000,000'' and inserting ``$6,738,000,000''. SEC. 4. DETERMINATION OF BUDGETARY EFFECTS.
The budgetary effects of this Act, for the purpose of complying with the Statutory Pay-As-You-Go Act of 2010, shall be determined by reference to the latest statement titled ``Budgetary Effects of PAYGO Legislation'' for this Act, submitted for printing in the Congressional Record by the Chairman of the House Budget Committee, provided that such statement has been submitted prior to the vote on passage.
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Mr. PALLONE. 3630.
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Mr. PALLONE.
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Mr. PALLONE. Mr. Speaker, I rise to speak in support of H.R. 3630, the Lymphedema Treatment Act. This bipartisan legislation sponsored by Representative Schakowsky will help Medicare beneficiaries suffering from lymphedema access needed compression garments.
Lymphedema is a condition caused by a chronic failure of the lymphatic system that results in the accumulation of lymph fluid and swelling in various parts of the body. Lymphedema can sometimes be a congenital condition but is more often a secondary complication of common health issues like burns or cancer.
Altogether, an estimated 3 to 5 million Americans are affected by this chronic condition, and if left untreated, individuals have a higher risk of hospitalization, disability, and even death.
While there is no known cure for lymphedema, it can be effectively treated and managed. Compression therapy is a critical component of treatment.
While Medicare covers some lymphedema treatments like compression pumps, Medicare does not cover the compression garments needed for ongoing lymphedema management because it lacks the legislative authority to cover these items.
The Lymphedema Treatment Act will close the unintended gap in coverage that prevents Medicare beneficiaries from accessing medically necessary, prescribed compression garments.
I thank Representative Schakowsky for her longtime advocacy on this issue and the more than 350 bipartisan Members who signed on in support of this legislation. This bill passed out of the Energy and Commerce Committee in July by a unanimous vote, and it will help ensure that patients with lymphedema have access to the full range of treatment they need.
Mr. Speaker, I urge its passage, and I reserve the balance of my time.
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Mr. PALLONE. Schakowsky), the sponsor of this legislation and the chairwoman of the subcommittee.
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Mr. PALLONE. Mr. Speaker, I also urge passage of this bill, another bipartisan bill where we all worked together from the Energy and Commerce Committee, and I yield back the balance of my time.
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