Sec. 806. Medicare coverage of certain lymphedema compression treatment items
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Section 1861 of the Social Security Act ( 42 U.S.C. 1395x ), as amended by section 601 and section 603, is further amended— in subsection (s)(2)— in subparagraph (II), by striking and after the semicolon at the end; in subparagraph (JJ), by striking the period at the end and inserting ; and ; and by adding at the end the following new subparagraph: lymphedema compression treatment items (as defined in subsection (mmm)); ; and by adding at the end the following new subsection:
The term lymphedema compression treatment items means compression garments, devices, bandaging systems, components, and supplies, including multilayer compression bandaging systems, standard fit gradient compression garments, and other compression garments, devices, bandaging systems, components, or supplies (as determined by the Secretary), that are— furnished on or after January 1, 2022, to an individual with a diagnosis of lymphedema for the treatment of such condition; primarily and customarily used in the medical treatment of lymphedema, as determined by the Secretary; and 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). .
Section 1833(a)(1) of the Social Security Act ( 42 U.S.C. 1395l(a)(1) ), as amended by section 601(c)(1), is further amended— by striking and before
(DD); and by inserting before the semicolon at the end the following: , and
(EE)with respect to lymphedema compression treatment items (as defined in section 1861(mmm)), 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) . Section 1834 of the Social Security Act ( 42 U.S.C. 1395m ), as amended by sections 601(c)(2) and 603(c), is further amended by adding at the end the following new subsection: The Secretary shall determine an appropriate payment basis for lymphedema compression treatment items (as defined in section 1861(mmm)). 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. No payment may be made under this part for lymphedema compression treatment items furnished other than at such frequency as the Secretary may establish. 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)— 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 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. . Section 1862(a)(1) of the Social Security Act ( 42 U.S.C. 1395y(a)(1) ), as amended by section 601(f) and section 603(g), is further amended— in subparagraph (Q), by striking and at the end; in subparagraph (R), by striking the semicolon and inserting , and ; and by adding at the end the following new subparagraph: in the case of lymphedema compression treatment items (as defined in section 1861(mmm)), which are furnished more frequently than is established pursuant to section 1834(z)(2); . Section 1847(a)(2) of the Social Security Act ( 42 U.S.C. 1395w–3(a)(2) ), as amended by sections 601(e)(2)(B)(ii), 602(b)(3)(B)(i), and 603(f)(2)(B), is further amended by adding at the end the following new subparagraph: Lymphedema compression treatment items (as defined in section 1861(mmm)) for which payment would otherwise be made under section 1834(z). . Section 1834(j)(5) of the Social Security Act ( 42 U.S.C. 1395m(j)(5) ) is amended— by redesignating subparagraphs
(E)and
(F)as subparagraphs
(F)and (G), respectively; and by inserting after subparagraph
(D)the following new subparagraph: lymphedema compression treatment items (as defined in section 1861(mmm)); . The Secretary of Health and Human Services (in this section referred to as the Secretary ) shall conduct a study on the implementation of Medicare coverage of certain lymphedema compression treatment items under the amendments made by this Act. Such study shall include an evaluation of the following: Medicare beneficiary utilization of items and services under parts A and B of title XVIII of the Social Security Act as a result of the implementation of such amendments. Whether the Secretary has determined, pursuant to section 1861(mmm) of the Social Security Act, as added by subsection (a)(1), that lymphedema compression treatment items other than compression bandaging systems and standard fit gradient compression garments are covered under such section. Not later than January 1, 2024, the Secretary shall submit to Congress and make available to the public a report on the study conducted under paragraph (1).
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- 42 USC 1395w–3(a)(2)
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Sec. 806
Medicare coverage of certain lymphedema compression treatment items
Cite42 USC 1395w–3(a)(2)
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