Understanding the Lymphedema Treatment Act
Lymphedema is a condition that affects an estimated 3 to 5 million Americans. Currently, lymphedema treatment is considered a "secondary" benefit under Medicare and private insurance plans, resulting in limited or no coverage. This puts a heavy financial burden on patients, who often have to pay for costly lymphedema treatments out of pocket or forgo treatment altogether. Doctor-prescribed compression supplies are critical components of lymphedema treatment, but Medicare and similar policies do not currently cover their daily use. This makes the treatment difficult and unaffordable for many patients.
Effective December 23, 2022, the Lymphedema Treatment Act was signed into law with an effective date set for January 1, 2024.
The legislation received widespread support from patient advocacy groups, healthcare providers, lawmakers, and medical organizations such as the American Cancer Society and the National Lymphedema Network, and will enhance Medicare coverage for doctor-prescribed compression supplies, which are essential for treating lymphedema.
In preparation for the implementation of the act, the Centers for Medicare and Medicaid Services (CMS) is currently consulting with various lymphedema stakeholders. Towards the end of the second quarter, the organization plans to release a guidance document outlining:
- Who is eligible for coverage
- Under what circumstances
- What specific supplies are covered (including type, quantity, and frequency)
With this guidance, patients and healthcare providers will have a clearer understanding of the specifics of the law and how it will be implemented.
Resources for learning more about the Lymphedema Treatment Act
There are several available resources individuals can explore to learn more about the new law and its implementation, including:
- The Lymphedema Advocacy Group (LAG) website offers comprehensive information about the law's history, status, and provisions. The website also provides tools that individuals can use to contact their elected officials and advocate for lymphedema treatment coverage. Additionally, the LAG website offers downloadable brochures and fact sheets that patients and healthcare providers can use to educate others about the importance of lymphedema treatment coverage.
- The National Lymphedema Network (NLN) also provides resources related to the Lymphedema Treatment Act on its website. This includes information on advocacy efforts, updates on the implementation process, and educational resources for healthcare providers and patients.
- The Center for Medicare and Medicaid Services (CMS) website is another resource for individuals interested in the law's implementation. The website provides updates on guidance documents, local coverage determinations, and fee schedules related to the law.
Use your voice and join us in the fight to increase access to more advanced lymphedema treatments.
While the Lymphedema Treatment Act is an important step forward, there is still much to be done to improve the lives of those living with lymphedema. There are several ways for you to stay involved and advocate for legislation that supports more advanced lymphedema treatments.
Step 1: Contact your members of Congress and share your story.
Even after a bill is passed, it can take time for it to be fully implemented. Advocates can work to ensure that the Lymphedema Treatment Act is implemented in a timely and effective manner by contacting their elected officials, sharing their stories, and validating the importance of this legislation.
Convey why your doctor-prescribed compression garments are an essential part of your health and quality of life and focus on why these garments are a medical necessity, not on the cost. Medical necessity is the driving force behind legislative action – not the cost of medical supplies or one’s ability to pay out of pocket.
Step 2: Raise awareness in your community.
The Lymphedema Treatment Act has advocacy teams in all 50 states. Joining the team is free and does not require any prior advocacy experience. As advocacy opportunities arise, you can be a part of raising awareness, educating communities, and generating funding for research and treatment.
Step 3: Continue to Support Additional Legislation
We must continue to advocate for additional legislation that supports access to more advanced treatments for those with lymphedema. Surgical procedures, such as lymphaticovenular bypass or lymph node transfer, can help to alleviate the symptoms of lymphedema and improve quality of life.
Our Promise to You:
The Advanced Reconstructive Surgery Alliance (ARSA) will continue to serve the needs of patients by providing the highest standard of clinical care and generating legislative support for important bills like the Lymphedema Treatment Act. We understand that access to supplies and treatments can make a significant difference in the quality of life for patients and their families, and we are dedicated to ensuring that access for those who need it most.