The Lymphedema Treatment Act is law. So now what?

After over a decade of advocacy, lobbying, educating, and more, the Lymphedema Treatment Act (LTA) was finally signed into law. The LTA is now reality as a result of the tireless dedication of patients, caregivers, healthcare professionals, and more.

However, this doesn’t mean that we can sit back and relax. Sure, we can give ourselves a pat on the back.  But, it is just as important that we continue the advocacy and education to now ensure the appropriate implementation of the Lymphedema Treatment Act. 

I invited Sarah Bramblette from the Lymphedema Advocacy Group to share what this bill means for us and our patients, and what we must do moving forward to close the care gap for all patients with lymphedema.

The Lymphedema Treatment Act closes the unintended gap in Medicare coverage for lymphedema garments & supplies.

According to the LTA website, “The LTA will improve coverage for the treatment of lymphedema from any cause by amending Medicare statute to allow for coverage of compression supplies. Although this legislation relates specifically to a change in Medicare law, it would set a precedent for Medicaid and private insurers to follow.”

This federal law was passed on December 23, 2022 & will go into effect on January 1, 2024.  

Previously, lymphedema garments really didn’t fit into any established category.

Previously, CMS stated that they could not cover lymphedema compression garments because they didn’t really fit under durable medical equipment or any other category they had established. So it was never a malicious exclusion, or that CMS didn’t recognize that lymphedema was a problem: it’s just that these garments didn’t fit into an established benefit category. 

This bill covers garments, but not lymphedema surgery, for a very particular reason.

Currently there is an established benefit for surgery through CMS. However, because there wasn’t an established benefit category where lymphedema garments and supplies would fit, it literally took an act of Congress to establish this new benefit category.

But what about my patients not on Medicare & Medicaid?

Many commercial insurances follow the standard put forward by CMS.  In fact, some states are already mandating expanded lymphedema compression garment coverage.  However, this will still be a process to get widespread coverage for all patients.

While the Lymphedema Treatment Act is officially law now, the work isn’t over yet.

Throughout 2023, Lymphedema Advocacy Group & other groups will be working with the Center for Medicare & Medicaid Services (CMS) to establish the specifics of garment coverage.  It’s critical that we remain engaged to establish appropriate coverage for patients (such as number of garments, etc.).

For the latest on what you can do, subscribe to the Lymphedema Treatment Act newsletter for all the latest updates.

Until next time, this is Elise with TheOncoPT. And remember you are exactly the physical therapist that your patients with cancer need. So let’s get to work.

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