Lymphedema Treatment Act

117TH CONGRESS 2D SESSION H. R. 3630 AN ACT To amend title XVIII of the Social Security Act to provide for coverage of certain lymphedema compression treat- ment items under the Medicare program. Be it enacted by the Senate and House of Representa- 1 tives of the United States of America in Congress assembled, 2 2 •HR 3630 EH SECTION 1. SHORT TITLE. 1 This Act may be cited as the ‘‘Lymphedema Treat- 2 ment Act’’. 3 SEC. 2. MEDICARE COVERAGE OF CERTAIN LYMPHEDEMA 4 COMPRESSION TREATMENT ITEMS. 5 (a) COVERAGE.— 6 (1) IN GENERAL.—Section 1861 of the Social 7 Security Act (42 U.S.C. 1395x) is amended— 8 (A) in subsection (s)(2)— 9 (i) in subparagraph (GG), by striking 10 ‘‘and’’ after the semicolon at the end; 11 (ii) in subparagraph (HH), by strik- 12 ing the period at the end and inserting ‘‘; 13 and’’; and 14 (iii) by adding at the end the fol- 15 lowing new subparagraph: 16 ‘‘(II) lymphedema compression treatment items 17 (as defined in subsection (lll));’’; and 18 (B) by adding at the end the following new 19 subsection: 20 ‘‘(lll) LYMPHEDEMA COMPRESSION TREATMENT 21 ITEMS.—The term ‘lymphedema compression treatment 22 items’ means standard and custom fitted gradient com- 23 pression garments and other items determined by the Sec- 24 retary that are— 25 3 •HR 3630 EH ‘‘(1) furnished on or after January 1, 2024, to 1 an individual with a diagnosis of lymphedema for the 2 treatment of such condition; 3 ‘‘(2) primarily and customarily used to serve a 4 medical purpose and for the treatment of 5 lymphedema, as determined by the Secretary; and 6 ‘‘(3) prescribed by a physician (or a physician 7 assistant, nurse practitioner, or a clinical nurse spe- 8 cialist (as those terms are defined in section 9 1861(aa)(5)) to the extent authorized under State 10 law).’’. 11 (2) PAYMENT.— 12 (A) IN GENERAL.—Section 1833(a)(1) of 13 the Social Security Act (42 U.S.C. 1395l(a)(1)) 14 is amended— 15 (i) by striking ‘‘, and’’ before ‘‘(EE)’’; 16 and 17 (ii) by inserting before the semicolon 18 at the end the following: ‘‘, and (FF) with 19 respect to lymphedema compression treat- 20 ment items (as defined in section 21 1861(lll)), the amount paid shall be equal 22 to 80 percent of the lesser of the actual 23 charge or the amount determined under 24 4 •HR 3630 EH the payment basis determined under sec- 1 tion 1834(z)’’. 2 (B) PAYMENT BASIS AND LIMITATIONS.— 3 Section 1834 of the Social Security Act (42 4 U.S.C. 1395m) is amended by adding at the 5 end the following new subsection: 6 ‘‘(z) PAYMENT FOR LYMPHEDEMA COMPRESSION 7 TREATMENT ITEMS.— 8 ‘‘(1) IN GENERAL.—The Secretary shall deter- 9 mine an appropriate payment basis for lymphedema 10 compression treatment items (as defined in section 11 1861(lll)). In making such a determination, the Sec- 12 retary may take into account payment rates for such 13 items under State plans (or waivers of such plans) 14 under title XIX, the Veterans Health Administra- 15 tion, and group health plans and health insurance 16 coverage (as such terms are defined in section 2791 17 of the Public Health Service Act), and such other in- 18 formation as the Secretary determines appropriate. 19 ‘‘(2) FREQUENCY LIMITATION.—No payment 20 may be made under this part for lymphedema com- 21 pression treatment items furnished other than at 22 such frequency as the Secretary may establish. 23 ‘‘(3) APPLICATION OF COMPETITIVE ACQUISI- 24 TION.—In the case of lymphedema compression 25 5 •HR 3630 EH treatment items that are included in a competitive 1 acquisition program in a competitive acquisition area 2 under section 1847(a)— 3 ‘‘(A) the payment basis under this sub- 4 section for such items furnished in such area 5 shall be the payment basis determined under 6 such competitive acquisition program; and 7 ‘‘(B) the Secretary may use information on 8 the payment determined under such competitive 9 acquisition programs to adjust the payment 10 amount otherwise determined under this sub- 11 section for an area that is not a competitive ac- 12 quisition area under section 1847, and in the 13 case of such adjustment, paragraphs (8) and 14 (9) of section 1842(b) shall not be applied.’’. 15 (3) CONFORMING AMENDMENT.—Section 16 1847(a)(2) of the Social Security Act (42 U.S.C. 17 1395w–3(a)(2)) is amended by adding at the end 18 the following new subparagraph: 19 ‘‘(D) LYMPHEDEMA COMPRESSION TREAT- 20 MENT ITEMS.—Lymphedema compression treat- 21 ment items (as defined in section 1861(lll)) for 22 which payment would otherwise be made under 23 section 1834(z).’’. 24 6 •HR 3630 EH (b) INCLUSION IN REQUIREMENTS FOR SUPPLIERS 1 OF MEDICAL EQUIPMENT AND SUPPLIES.—Section 1834 2 of the Social Security Act (42 U.S.C. 1395m) is amend- 3 ed— 4 (1) in subsection (a)(20)(D), by adding at the 5 end the following new clause: 6 ‘‘(iv) Lymphedema compression treat- 7 ment items (as defined in section 8 1861(lll)).’’. 9 (2) in subsection (j)(5)— 10 (A) by redesignating subparagraphs (E) 11 and (F) as subparagraphs (F) and (G), respec- 12 tively; and 13 (B) by inserting after subparagraph (D) 14 the following new subparagraph: 15 ‘‘(E) lymphedema compression treatment 16 items (as defined in section 1861(lll));’’. 17 SEC. 3. MEDICARE IMPROVEMENT FUND. 18 Section 1898(b)(1) of the Social Security Act (42 19 U.S.C. 1395iii(b)(1)) is amended by striking 20 ‘‘$7,308,000,000’’ and inserting ‘‘$6,738,000,000’’. 21 SEC. 4. DETERMINATION OF BUDGETARY EFFECTS. 22 The budgetary effects of this Act, for the purpose of 23 complying with the Statutory Pay-As-You-Go Act of 2010, 24 shall be determined by reference to the latest statement 25 7 •HR 3630 EH titled ‘‘Budgetary Effects of PAYGO Legislation’’ for this 1 Act, submitted for printing in the Congressional Record 2 by the Chairman of the House Budget Committee, pro- 3 vided that such statement has been submitted prior to the 4 vote on passage. 5 Passed the House of Representatives November 17, 2022. Attest: Clerk. 117TH CONGRESS 2D SESSION H. R. 3630 AN ACT To amend title XVIII of the Social Security Act to provide for coverage of certain lymphedema com- pression treatment items under the Medicare program.