[Congressional Bills 112th Congress]
[From the U.S. Government Publishing Office]
[H.R. 2499 Introduced in House (IH)]

112th CONGRESS
  1st Session
                                H. R. 2499

    To amend title XVIII of the Social Security Act to improve the 
diagnosis and treatment of lymphedema under the Medicare program and to 
reduce costs under such program related to the treatment of lymphedema.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                             July 12, 2011

     Mr. Kissell (for himself, Mr. Roe of Tennessee, Mr. Paul, Mr. 
Blumenauer, Mr. Rangel, Ms. Brown of Florida, Mr. Coble, Mr. Holt, Ms. 
   Richardson, Mr. Connolly of Virginia, Mr. Michaud, Ms. Moore, Mr. 
  Jackson of Illinois, Ms. Norton, Mr. Miller of North Carolina, Mr. 
 Frank of Massachusetts, Mr. Schiff, and Mr. Price of North Carolina) 
 introduced the following bill; which was referred to the Committee on 
   Energy and Commerce, and in addition to the Committee on Ways and 
 Means, for a period to be subsequently determined by the Speaker, in 
   each case for consideration of such provisions as fall within the 
                jurisdiction of the committee concerned

_______________________________________________________________________

                                 A BILL


 
    To amend title XVIII of the Social Security Act to improve the 
diagnosis and treatment of lymphedema under the Medicare program and to 
reduce costs under such program related to the treatment of lymphedema.

    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 Diagnosis and Treatment 
Cost-Saving Act of 2011''.

SEC. 2. COVERAGE OF LYMPHEDEMA DIAGNOSIS AND TREATMENT SERVICES UNDER 
              MEDICARE.

    (a) Coverage of Services.--Section 1861 of the Social Security Act 
(42 U.S.C. 1395x) is amended--
            (1) in subsection (s)(2)--
                    (A) in subparagraph (EE), by striking ``and'' at 
                the end;
                    (B) in subparagraph (FF), by adding ``and'' at the 
                end; and
                    (C) by adding at the end the following new 
                subparagraph:
                    ``(GG)(i) lymphedema diagnosis services (as defined 
                in subsection (iii)(1)) and lymphedema treatment 
                services (as described in subsection (iii)(2)); and
                    ``(ii) lymphedema compression treatment items (as 
                defined in subsection (jjj)).''; and
            (2) by adding at the end the following new subsections:
    ``(iii) Lymphedema Diagnosis and Treatment Services.--(1) 
Lymphedema Diagnosis Services.--The term `lymphedema diagnosis 
services' means, with respect to an individual, the differential 
diagnosis of the source of the individual's edema and the 
identification of the specific etiology and functional lymphatic 
deficiency, in which such diagnosis--
            ``(A) is provided by a provider, as defined in paragraph 
        (3), for the purpose of developing a lymphedema treatment plan; 
        and
            ``(B) may utilize any diagnostic tools the provider 
        determines to be reasonable and necessary.
    ``(2) Lymphedema Treatment Services.--The term `lymphedema 
treatment services' means, with respect to an individual, services for 
the treatment of lymphedema (regardless of cause)--
            ``(A) that are--
                    ``(i) provided in an inpatient or outpatient 
                setting;
                    ``(ii) provided by a provider, as defined in 
                paragraph (3), within the established scope of practice 
                of such provider; and
                    ``(iii) medically necessary, in accordance with the 
                current standard of lymphedema treatment, including 
                complete decongestive therapy, which is a multi-modal 
                therapy comprising of manual lymph drainage, 
                compression therapy utilizing multilayer bandage 
                systems, compression garments and devices, exercise, 
                skin care, patient education, and any other lymphedema 
                treatment modalities determined by the Secretary to be 
                safe and effective; and
            ``(B) which shall--
                    ``(i) include as medically necessary with respect 
                to the individual--
                            ``(I) an initial evaluation and course of 
                        clinical treatment, including initial baseline 
                        measurements and subsequent measurements to 
                        assess treatment efficacy and progress;
                            ``(II) follow-up courses of clinical 
                        treatment;
                            ``(III) in the case that such individual 
                        has cancer, clinical measurements, including 
                        initial pre-operative baseline measurements and 
                        periodic subsequent measurements to diagnose 
                        the presence of lymphedema; and
                            ``(IV) any other treatment modality 
                        approved by the Secretary; and
                    ``(ii) be provided in accordance with such 
                schedule, duration, and number of treatments as 
                determined medically necessary.
    ``(3) Provider Defined.--For purposes of this subsection and 
subsection (jjj), the term `provider' means any licensed medical or 
health care provider whose State licensing board recognizes lymphedema 
diagnosis, lymphedema treatment, or both to fall within the scope of 
practice of such medical or health care provider.
    ``(jjj) Lymphedema Compression Treatment Items.--The term 
`lymphedema compression treatment items' means, with respect to an 
individual, compression garments, devices, bandaging systems, 
components, and supplies that are primarily and customarily used in the 
medical treatment of lymphedema of the arms, hands, legs, feet, torso, 
face and neck, breast and chest, abdomen, and genitalia, as prescribed 
by a provider, as defined in subsection (iii)(3). Such term includes--
            ``(1) multilayer compression bandaging systems, including 
        short-stretch and medium-stretch compression bandages; cotton, 
        synthetic, or foam padding; gauze or elastic finger and toe 
        bandages; foam pads; directional flow padding; and tubular 
        bandages;
            ``(2) custom or standard fit gradient compression garments;
            ``(3) non-elastic and low-elastic compression garments, 
        manually adjustable or fitted padded directional flow garments 
        (with or without elastic or non-elastic compression jackets) 
        and compression wraps and directional flow pads;
            ``(4) aids and ancillary equipment consisting of donning 
        aids, bandage rollers, shoes to fit over compression items, and 
        other specialized items used with the items described in 
        paragraphs (1) through (3);
            ``(5) pneumatic appliances connected to and used in 
        conjunction with pneumatic sequential compression controllers;
            ``(6) any other compression garments, bandaging systems, 
        devices, and aids determined by the Secretary to be effective 
        in the prevention or treatment of lymphedema; and
            ``(7) replacements of any items under this subsection in 
        accordance with section 1834(p)(3).''.
    (b) Payment.--
            (1) Lymphedema compression treatment items.--
                    (A) In general.--Section 1833(a) of such Act (42 
                U.S.C. 1395l(a)) is amended--
                            (i) in paragraph (8), by striking at the 
                        end ``and'';
                            (ii) in paragraph (9), by striking at the 
                        end the period and inserting a semi-colon; and
                            (iii) by adding at the end the following 
                        new paragraph:
            ``(10) in the case of lymphedema compression treatment 
        items described in section 1861(jjj), the amount determined 
        under section 1834(p); and''.
                    (B) Payment determined.--Section 1834 of such Act 
                (42 U.S.C. 1395m) is amended by adding at the end the 
                following new subsection:
    ``(p) Payment for Lymphedema Compression Treatment Items.--
            ``(1) General rule for payment.--
                    ``(A) In general.--With respect to a lymphedema 
                compression treatment item as defined in section 
                1861(jjj)) for which payment is determined under this 
                subsection, subject to subparagraph (D), payment shall 
                be made in an amount equal to 80 percent of the payment 
                basis described in subparagraph (B).
                    ``(B) Payment basis.--The payment basis described 
                in this subparagraph, with respect to a lymphedema 
                compression treatment item described in section 
                1861(jjj), is the actual charge for the item.
                    ``(C) Exclusive payment rule for home health 
                agencies.--Notwithstanding any other provision of this 
                title, this subsection shall constitute the exclusive 
                provision of this title for payment for lymphedema 
                compression treatment items described in section 
                1861(jjj) under this part or under part A to a home 
                health agency or for such items that are furnished as 
                an incident to a physician's professional service.
            ``(2) Allowable quantities.--In the case it is determined 
        by a provider, as defined in section 1861(iii)(3), that 
        lymphedema compression treatment items are required as part of 
        lymphedema treatment services under section 1861(iii)(2), then 
        payment may be made under this title in accordance with this 
        subsection for such items in the quantity which is customary, 
        reasonable, and medically necessary.
            ``(3) Replacement of lymphedema compression treatment 
        items.--
                    ``(A) In general.--Payment shall be made under this 
                subsection, with respect to an individual, for the 
                replacement of a lymphedema compression treatment item 
                if the period of the reasonable and useful lifetime of 
                the item (as described in subparagraph (B)) has expired 
                or a provider, as defined in section 1861(iii)(3), 
                determines that a replacement, or repair, of such item, 
                is medically necessary.
                    ``(B) Reasonable and useful lifetime.--For purposes 
                of subparagraph (A), the period of the reasonable and 
                useful lifetime of a lymphedema compression treatment 
                item is as follows:
                            ``(i) In the case of any item described in 
                        section 1861(jjj)(1), 1 year.
                            ``(ii) In the case of any item described in 
                        section 1861(jjj)(2), 6 months.
                            ``(iii) In the case of any item described 
                        in section 1861(jjj)(3), 2 years.
                            ``(iv) In the case of any item described in 
                        section 1861(jjj)(4), 1 year.
                            ``(v) In the case of any item described in 
                        section 1861(jjj)(5), 5 years.
                            ``(vi) In the case of any item described in 
                        section 1861(jjj)(6), such period as determined 
                        by the Secretary, in consultation with 
                        appropriate health organizations, at the time 
                        the Secretary determines such item to be 
                        effective in the prevention or treatment of 
                        lymphedema.''.
                    (C) Application of supplier requirements.--Section 
                1834(j)(5) of such Act (42 U.S.C. 1395m(j)(5)) is 
                amended--
                            (i) in subparagraph (E), by striking at the 
                        end ``and'';
                            (ii) in subparagraph (F), by striking at 
                        the end the period and inserting ``; and''; and
                            (iii) by adding at the end the following 
                        new subparagraph:
                    ``(G) lymphedema compression treatment items (as 
                defined in section 1861(jjj)).''.
            (2) Lymphedema diagnosis and treatment services.--
                    (A) In general.--Section 1833(a) of such Act, as 
                amended by paragraph (1)(A), is further amended by 
                adding at the end the following new paragraph:
            ``(11)(A) in the case of lymphedema diagnosis services (as 
        defined in section 1861(iii)(1)) furnished by a provider (as 
        defined in section 1861(iii)(3)) the amount described in 
        section 1834(q); and
            ``(B) in the case of lymphedema treatment services (as 
        defined in section 1861(iii)(2)) furnished by a provider (as 
        defined in section 1861(iii)(3)) the amount described in 
        section 1834(k).''.
                    (B) Payment method.--Section 1834 of such Act, as 
                amended by paragraph (1)(B), is further amended by 
                adding at the end the following new subsection:
    ``(q) Payment for Outpatient Lymphedema Diagnosis and Treatment 
Services by Physicians and Non-Physician Practitioners.--
            ``(1) In general.--For purposes of section 1833(a)(11), the 
        amount described in this subsection, with respect to a 
        lymphedema diagnosis service or lymphedema treatment service, 
        is 80 percent of the lesser of--
                    ``(A) the actual charge for the service; or
                    ``(B) the applicable fee schedule amount (as 
                defined in paragraph (2)) for the service.
            ``(2) Applicable fee schedule amount.--In this subsection, 
        the term `applicable fee schedule amount' means, with respect 
        to services furnished in a year, the amount determined under 
        the fee schedule established under section 1848 for such 
        services furnished during the year.''.
                    (C) Conforming amendment for payments under 
                1834(k).--Section 1834(k)(1) of such Act (42 U.S.C. 
                1395m(k)(1)) is amended by striking ``or 1833(a)(9)'' 
                and inserting ``1833(a)(9), or 1833(a)(11)''.
    (c) Effective Date.--The amendments made by this section shall 
apply to items and services furnished on or after the date that is 180 
days from the date of the enactment of this Act.
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