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Therapy Laws and Resources.
Deare Lymphedema Community,
This is a historic time for the lymphedema community nationwide. Legislative bill H.R. 4662 entitled "Lymphedema Diagnosis and Treatment Cost Saving Act of 2010" has been introduced in the House of Representatives by Congressman Larry Kissell of North Carolina. It has been co-sponsored by Congressman Ron Paul of Texas and Congressman Phil Roe of Tennessee.
The bill was written by NLN Legislative Advocate Bob Weiss. During the last 6 weeks he has worked closely with a Congressional Legislative Counsel and Congressman Kissell to re-work the text. At the same time many thanks are owed to Heather Ferguson, a young mom from North Carolina who was instrumental in securing coverage for treatment of lymphedema in North Carolina and subsequently convinced Congressman Kissell to sponsor this bill at the national level.
The bill has the goal of reducing total healthcare costs through avoidance of periodic infections, pain, and disabilities resulting from lymphedema. Specific goals of the bill are:
to provide diagnosis and treatment of individuals with and at risk for lymphedema according to current medical treatment standards, including manual lymph drainage, compression bandages, garments, devices, and exercise
to enhance quality of lymphedema patient care by providing therapist qualification requirements
to provide for lymphedema patient education in the procedures for self-treatment so as to transfer the treatment from the clinical to the home setting
to encourage patient self-treatment plan adherence by providing necessary medical supplies for use at home to expand patient access to qualified lymphedema therapy by extending coverage to qualified, trained lymphedema therapists who may practice under a qualified physician, physical therapist, or occupational therapist
We encourage you to contact your local Representatives and Senators. Please urge them to co-sponsor H.R. 4662 and to introduce a similar bill in the Senate. Please stress the fact that this bill is projected to save hundreds of millions of dollars every year in avoidance of costs of treating preventable lymphedema-related cellulitis. This is a quality of care issue affecting insured patients and is complementary to healthcare access issues. Time is of the essence for you who have had difficulty in obtaining proper lymphedema treatment for yourselves or your patients. We may never have a better opportunity!
After writing to your Congressional Representatives and Senators, we encourage you to forward a copy of your letters to the NLN (National Lymphedema Network) and they will send a follow up letter to your Representatives and/or Senators for additional support. They will copy you on the correspondence. You may contact the NLN via email here:
We hope you will take the very important action of supporting this milestone in lymphedema treatment.
The Women's Health and Cancer Rights Act of 1998 (Public Law 105-277) required group health plans to provide coverage for services related to mastectomy including prostheses and physical complications related to mastectomy, including lymphedema. Effective 2004, The Virginia General Assembly mandated coverage for lymphedema therapy when prescribed by an authorized health care provider.
Please be aware that the diagnosis of Lymphedema resulting from lymph node dissection as a result of Breast Cancer is a mandated service covered by New York State Insurance Law A07607 and Federal Law HR4328: Public Law. 105-277 Women’s Health and Cancer Rights Act.
Justification as quoted from the NYS assembly is as follows: Lymphedema is a debilitating condition involving the swelling of the limbs and body that occurs when the lymphatic system is impaired. Frequently, the condition manifests itself subsequent to cancer surgery. Effective treatment of lymphedema necessitates early diagnosis and therapy to improve tissue structure, combined with the use of compression sleeves to aid in the reduction of swelling.
The WHCRA of 1998, states that an insurer offering health insurance coverage may not, penalize or otherwise reduce or limit reimbursement of an attending provider, or provide incentives (monetary or otherwise) to an attending provider, to induce such a provider to provide care to an individual participant or beneficiary in a manner inconsistent with the Women’s Health and Cancer Rights Act of 1998
To reiterate the current legislation regarding the Treatment of Breast Cancer from the State of New York, under the Insurance Law A07607, March 27 2001, Section 1. subsection (i) of section 3216 of the insurance law is amended by a adding a new paragraph 24 to read: that every insured person shall be entitled to reimbursement for the costs associated with the diagnosis and treatment of Lymphedema. Such reimbursement shall also include the cost of compression sleeves used to alleviate the pain and discomfort of lymphedema.
Section 2. subsection (k) of section 3221 of the insurance law is amended by adding a new paragraph 13 to read: Every group policy issued or delivered in this state that provides medical coverage of any kind shall also provide coverage for the diagnosis and treatment of Lymphedema. Such reimbursement shall also include the cost of compression sleeves used to alleviate the pain and discomfort of lymphedema.
The New York State legislation is backed by prior Federal Law 1999 Omnibus Consolidated and Emergency Supplemental Appropriations Act (HR 4328 (Public Law 105-277) aka Women’s Health and Cancer Rights Act of 1998 which requires individual and employer group health plans (including indemnity, PPO, POS and HMO’s) that provide medical and surgical benefits with respect to mastectomy, to provide coverage for lymphedema treatment in a manner determined in consultation with the attending physician and the patient for a participant or beneficiary who is receiving benefits for a mastectomy and who elects breast reconstruction after the mastectomy. The law amends ERISA and Public Health statutes. Also known as the Women’s Health and Cancer Rights Act
The above-described procedural codes are integral parts of the Lymphedema Treatment Program and fall under the auspices of the Women’s Health & Cancer Rights Act.
This is a historic time for the lymphedema community nationwide. Legislative bill H.R. 4662 entitled "Lymphedema Diagnosis and Treatment Cost Saving Act of 2010" has been introduced in the House of Representatives by Congressman Larry Kissell of North Carolina. It has been co-sponsored by Congressman Ron Paul of Texas and Congressman Phil Roe of Tennessee.
The bill was written by NLN Legislative Advocate Bob Weiss. During the last 6 weeks he has worked closely with a Congressional Legislative Counsel and Congressman Kissell to re-work the text. At the same time many thanks are owed to Heather Ferguson, a young mom from North Carolina who was instrumental in securing coverage for treatment of lymphedema in North Carolina and subsequently convinced Congressman Kissell to sponsor this bill at the national level.
The bill has the goal of reducing total healthcare costs through avoidance of periodic infections, pain, and disabilities resulting from lymphedema. Specific goals of the bill are:
to provide diagnosis and treatment of individuals with and at risk for lymphedema according to current medical treatment standards, including manual lymph drainage, compression bandages, garments, devices, and exercise
to enhance quality of lymphedema patient care by providing therapist qualification requirements
to provide for lymphedema patient education in the procedures for self-treatment so as to transfer the treatment from the clinical to the home setting
to encourage patient self-treatment plan adherence by providing necessary medical supplies for use at home to expand patient access to qualified lymphedema therapy by extending coverage to qualified, trained lymphedema therapists who may practice under a qualified physician, physical therapist, or occupational therapist
We encourage you to contact your local Representatives and Senators. Please urge them to co-sponsor H.R. 4662 and to introduce a similar bill in the Senate. Please stress the fact that this bill is projected to save hundreds of millions of dollars every year in avoidance of costs of treating preventable lymphedema-related cellulitis. This is a quality of care issue affecting insured patients and is complementary to healthcare access issues. Time is of the essence for you who have had difficulty in obtaining proper lymphedema treatment for yourselves or your patients. We may never have a better opportunity!
After writing to your Congressional Representatives and Senators, we encourage you to forward a copy of your letters to the NLN (National Lymphedema Network) and they will send a follow up letter to your Representatives and/or Senators for additional support. They will copy you on the correspondence. You may contact the NLN via email here:
We hope you will take the very important action of supporting this milestone in lymphedema treatment.
The Women's Health and Cancer Rights Act of 1998 (Public Law 105-277) required group health plans to provide coverage for services related to mastectomy including prostheses and physical complications related to mastectomy, including lymphedema. Effective 2004, The Virginia General Assembly mandated coverage for lymphedema therapy when prescribed by an authorized health care provider.
Please be aware that the diagnosis of Lymphedema resulting from lymph node dissection as a result of Breast Cancer is a mandated service covered by New York State Insurance Law A07607 and Federal Law HR4328: Public Law. 105-277 Women’s Health and Cancer Rights Act.
Justification as quoted from the NYS assembly is as follows: Lymphedema is a debilitating condition involving the swelling of the limbs and body that occurs when the lymphatic system is impaired. Frequently, the condition manifests itself subsequent to cancer surgery. Effective treatment of lymphedema necessitates early diagnosis and therapy to improve tissue structure, combined with the use of compression sleeves to aid in the reduction of swelling.
The WHCRA of 1998, states that an insurer offering health insurance coverage may not, penalize or otherwise reduce or limit reimbursement of an attending provider, or provide incentives (monetary or otherwise) to an attending provider, to induce such a provider to provide care to an individual participant or beneficiary in a manner inconsistent with the Women’s Health and Cancer Rights Act of 1998
To reiterate the current legislation regarding the Treatment of Breast Cancer from the State of New York, under the Insurance Law A07607, March 27 2001, Section 1. subsection (i) of section 3216 of the insurance law is amended by a adding a new paragraph 24 to read: that every insured person shall be entitled to reimbursement for the costs associated with the diagnosis and treatment of Lymphedema. Such reimbursement shall also include the cost of compression sleeves used to alleviate the pain and discomfort of lymphedema.
Section 2. subsection (k) of section 3221 of the insurance law is amended by adding a new paragraph 13 to read: Every group policy issued or delivered in this state that provides medical coverage of any kind shall also provide coverage for the diagnosis and treatment of Lymphedema. Such reimbursement shall also include the cost of compression sleeves used to alleviate the pain and discomfort of lymphedema.
The New York State legislation is backed by prior Federal Law 1999 Omnibus Consolidated and Emergency Supplemental Appropriations Act (HR 4328 (Public Law 105-277) aka Women’s Health and Cancer Rights Act of 1998 which requires individual and employer group health plans (including indemnity, PPO, POS and HMO’s) that provide medical and surgical benefits with respect to mastectomy, to provide coverage for lymphedema treatment in a manner determined in consultation with the attending physician and the patient for a participant or beneficiary who is receiving benefits for a mastectomy and who elects breast reconstruction after the mastectomy. The law amends ERISA and Public Health statutes. Also known as the Women’s Health and Cancer Rights Act
The above-described procedural codes are integral parts of the Lymphedema Treatment Program and fall under the auspices of the Women’s Health & Cancer Rights Act.