Letter to the editor

Monday, April 26, 2010

I would like to submit a clarification that might make the intent and provisions of H.R. 4662, the Lymphedema Diagnosis and Treatment Cost Saving Act of 2010, a little clearer.

The bill is a comprehensive lymphedema treatment bill that defines the medical persons who can: 1) diagnose and prescribe treatment and DMEPOS; 2) apply hands-on treatment, and; 3) provide measurement and fitting services for compression items for the treatment of lymphedema. There are three separate lists of healthcare persons that were combined and confused in the “Bill mandates coverage for lymphedema items” (HME News, April 2010). The bill was written in this way to conform with the Social Security Act, which governs Medicare. To summarize section 1861 changes:

4    Only treating physicians can prescribe and review treatment;

4    Only specially-trained physical or occupational therapists, physicians, nurses, chiropractors (or therapy assistants, physician’s assistants, licensed nurses, massage therapists who have lymphedema training while treating under direct qualified supervision) can provide hands-on therapy and patient education on home self-care.

Section 1834 as modified provides:

4    Payment for compression materials prescribed by a physician, used as part of a lymphedema treatment plan to treat diagnosed lymphedema, and used by a patient who has been instructed in the proper use and care of the materials;

4    Compression treatment items must be fitted by a licensed or certified prosthetist or orthotist or a supplier who is certified by the manufacturer of the particular garment or device; and

4    Compression materials must be provided by a DMEPOS supplier who meets current requirements for suppliers of medical equipment and supplies.

Unfortunately, there’s confusion over the persons who can provide the garments and the persons who can provide hands-on therapy and the persons who can provide measurement and fitting services.

What would be added to existing Medicare services is a new DMEPOS benefit category of “compression materials” to the existing benefit categories of DME, surgical dressings, prosthetics, orthotics and prosthetic devices. This new category would cover compression bandage systems; compression garments; compression devices, such as strapped or elastic compression directional flow garments; and compression boots used in the compression therapy of diagnosed lymphedema when prescribed by a physician and used as part of a lymphedema treatment plan.

– Robert Weiss, lymphedema patient advocate, National Lymphedema Network