[Congressional Record Volume 168, Number 175 (Monday, November 14, 2022)]
[House]
[Pages H8469-H8471]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
LYMPHEDEMA TREATMENT ACT
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.
[[Page H8470]]
The SPEAKER pro tempore (Mr. Cuellar). Pursuant to the rule, the
gentleman from New Jersey (Mr. Pallone) and the gentleman from Florida
(Mr. Bilirakis) each will control 20 minutes.
The Chair recognizes the gentleman from New Jersey.
General Leave
Mr. PALLONE. Mr. Speaker, I ask unanimous consent that all Members
may have 5 legislative days in which to revise and extend their remarks
and include extraneous material on H.R. 3630.
The SPEAKER pro tempore. Is there objection to the request of the
gentleman from New Jersey?
There was no objection.
Mr. PALLONE. Mr. Speaker, I yield myself such time as I may consume.
{time} 1600
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.
Mr. BILIRAKIS. Mr. Speaker, I yield myself such time as I may
consume.
Mr. Speaker, I rise today in support of H.R. 3630, the Lymphedema
Treatment Act, introduced by my friend and fellow Committee on Energy
and Commerce member Jan Schakowsky, as well as the Subcommittee on
Health member Buddy Carter, along with myself and more than 350 Members
on both sides of the aisle.
This legislation would create a new Medicare benefit category,
lymphedema compression treatment items, including standard and custom-
fitted garments, and other items determined by HHS, for treatment of
lymphedema.
As many of us know, thanks to a passionate and committed group of
patient stakeholders, lymphedema is a chronic condition that may cause
significant swelling and discomfort. It is often located in the arms
and legs but can also occur in other parts of the body.
Unfortunately, there is no cure today for this condition, but
patients are able to receive care that can mitigate some of the
symptoms caused by lymphedema. One of the most basic elements of care
is the application of compression garments to swollen body parts.
As it stands today, fee-for-service Medicare covers various forms of
treatment for lymphedema but does not cover the basic compression
supplies typically used in the regular treatment for this condition.
This is a result of the outdated structure of traditional fee-for-
service Medicare, which does not have an existing benefit category that
works for lymphedema compression garments.
This legislation is yet another reminder that the fee-for-service
Medicare as structured today under part B simply cannot keep pace with
medical innovation. Private payers, including Medicare Advantage plans,
have more flexibility to provide coverage for these products,
especially if they add value to the care patients need.
As the popularity of Medicare Advantage demonstrates, there is a
built-in incentive to provide better value for patients, meaning better
outcomes and lower costs. It has been proven.
It has been discouraging to see an ever-growing number of situations
where a particular drug--for instance, an entire class of Alzheimer's
drugs recently restricted by CMS--or other medical products are not
covered for seniors in Medicare fee-for-service when other patients in
the private market, or even in Medicare Advantage, may have them
covered.
I am hopeful that bills like the one that we are here to discuss
today, where Congress continues to patch the inefficiencies in the
Medicare program, not only benefit seniors but also help all of us
recognize that seniors deserve greater Medicare reforms. Those reforms
should empower patients with greater control over their healthcare
decisions and more ability to tailor their health benefits to their
personal needs, all with the goal of no senior being denied or having
to lobby Congress to get the medical products they need. It makes
sense.
Finally, I am encouraged to see that the new mandatory spending in
this legislation will be fully offset, and I encourage my colleagues to
continue to insist that we fully offset mandatory spending now and into
the future. This is responsible. It is responsible legislating.
Mr. Speaker, I thank the sponsors for this bill, H.R. 3630, and the
chairman, of course, and the ranking member of the full committee. I
fully support this legislation and recommend a ``yes'' vote on final
passage.
Mr. Speaker, I reserve the balance of my time.
Mr. PALLONE. Mr. Speaker, I yield such time as she may consume to the
gentlewoman from Illinois (Ms. Schakowsky), the sponsor of this
legislation and the chairwoman of the subcommittee.
Ms. SCHAKOWSKY. Mr. Speaker, I thank the chairman of the committee
for yielding.
I am just so happy that we see the Lymphedema Treatment Act on the
floor today.
I thank my colleague on the Republican side, Buddy Carter, for being
a cosponsor of the legislation and helping to put it forward with so
many bipartisan sponsors of the legislation, over 350--what is it,
366?--cosponsors of the bill.
I look forward to passing it in the House today. There are enough
Senators on the other side of the rotunda here that also have
sponsored, so I look forward to it becoming the law of the land.
I thank all the advocates who worked so hard, including Heather
Ferguson, who is the executive director of the Lymphedema Advocacy
Group, and all the people whom she worked with to help make this pass.
Heather is the mother of a son that has lymphedema. I thank all the
constituents who worked so hard to make this happen.
Here is what it is about lymphedema. It is not only painful and
debilitating; it is also incurable. But we are lucky that there
actually is a remedy, a treatment for lymphedema.
Many of you may be familiar with it. You may not have known the name.
Two-thirds of all lymphedema cases develop after cancer treatment. You
see that swelling. But what we don't have is the kind of treatment that
is actually needed.
Currently, Medicare does not cover these important compression
garments, which is what can really help people so very much. My bill
will actually finally expand access to these garments for lymphedema
patients on Medicare.
This will absolutely help the 3 million Americans who have lymphedema
to be able to have some of the relief that they need at a cost that
they can afford. It will also reduce Medicare costs because instead of
these people developing all kinds of other health
[[Page H8471]]
issues, they will be able to be treated with these compression
garments.
Again, I thank Chairman Pallone, Ranking Member Cathy McMorris
Rodgers, Representative Buddy Carter, and all the Members on both sides
of the aisle. Mr. Speaker, I urge everyone to endorse this wonderful
bill and vote ``yes.''
Mr. BILIRAKIS. Mr. Speaker, this is a real good bill, a bipartisan
bill. We worked very hard on it, and we have a great sponsor here and a
Republican sponsor in Representative Buddy Carter, and I urge that we
pass this as soon as possible. I assume the Senate will get to work and
get this done, as well.
Mr. Speaker, I yield back the balance of my time.
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.
The SPEAKER pro tempore. The question is on the motion offered by the
gentleman from New Jersey (Mr. Pallone) that the House suspend the
rules and pass the bill, H.R. 3630, as amended.
The question was taken.
The SPEAKER pro tempore. In the opinion of the Chair, two-thirds
being in the affirmative, the ayes have it.
Mr. ROSENDALE. Mr. Speaker, on that I demand the yeas and nays.
The yeas and nays were ordered.
The SPEAKER. Pursuant to clause 8 of rule XX, further proceedings on
this motion will be postponed.
____________________