DALLAS – The United States Medical Compression Alliance (USMCA) is working with Medtrade to offer additional information about the Lymphedema Treatment Act and what it means for the HME industry. USMCA represents the five main compression manufacturers: medi USA; Essity (parent company of the Jobst brand); Juzo; Lohmann & Rauscher; and Sigvaris.
USMCA along with other stakeholders have worked with CMS to implement the Lymphedema Treatment Act (LTA), and their efforts will extend to private health insurers in the future. At Medtrade, several of these organizations will come together to co-present, including Carmen Anderson, USMCA representative; Sarah M. Bramblette, MSHL, Lymphedema Advocacy Group; Bill Lobosco, SunMED Medical; and Noel Neil, ACU-Serve Corp.
TOPIC: Lymphedema Compression
WHEN: Wednesday, March 27 from 10:00 – 11:00
WHY: Product Categories To Consider
WHERE: Room D166
The 13-year road to LTA passage began with the Lymphedema Advocacy Group (LAG), an all-volunteer grassroots organization founded by Heather Ferguson. After working with her state representative to pass the North Carolina Lymphedema Diagnosis and Treatment Act, Ferguson turned her efforts to improving coverage nationwide.
In late 2009, she secured her Congressman as the sponsor for the first-ever federal Lymphedema Treatment Act. With the introduction of this legislation, it became apparent that an organization dedicated to improving insurance coverage for the treatment of lymphedema was needed. In 2010, Ferguson founded the LAG to build support and move a bill through Congress.
It took 13 years and the efforts of many advocates nationwide for the LTA to eventually be passed into law on December 23, 2022. As the LTA is implemented nationwide, HME providers are still learning about the landmark legislation.
Attendees with a Conference Pass will learn about:
- the Lymphedema Treatment Act—history and ongoing efforts from the LAG;
- the business side of compression, the call points, the customers, the patients, and clinicians;
- the US Medical Compression Alliance and the products the manufacturers provide; and
- the billing intricacies to be aware of with the new changes.
The LTA is welcome news for the industry, but Heather Ferguson points out that the legislation does have certain limitations. “Many people assumed that the LTA would do additional things such as improve coverage for surgeries, pumps, and other lymphedema-related treatment items or services,” she says. “These things were not and could not be included in the legislation, because benefit categories for those services and supplies already exist, so any modifications to coverage would need to be undertaken through regulatory action.
“Legislative action was needed to enable coverage for compression garments and supplies,” she continues, “because only Congress has the authority to create new Medicare benefit categories, and the reason the items were not previously covered was because they did not fit into any existing benefit category.”
In the long term, Ferguson and LAG advocates are optimistic that the LTA will work as intended—improving Medicare coverage and coverage under other plans as well. The session at Medtrade is one part of that mission.
“We were thrilled with almost all aspects of the Final Rule and look forward to other plans adopting the same comprehensive coverage,” Ferguson adds. “Important wins for patients included: recognition of coverage for all parts of the body, not just arms and legs; the calculation of allowable quantities based on sets of garments, not the number of pieces—with a set constituting one garment for each affected body part; and replacement frequencies of three sets of daytime garments every six months, and two sets of nighttime garments every two years.”