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Legislative Updates

• Legislative Corner. Does Incorrect Coding Lead to Medicare Denials?: Apr - Jun, 2012
• Legislative Corner. Appealing a Medicare or Insurance Denial: Jan – Mar, 2012
• Legislative Corner. LE Bill Redux: From H.R. 4662 to H.R. 2499: Oct - Dec, 2011
• Legislative Corner. Making a Medicare or Insurance Claim: Jul - Sep, 2011
• Legislative Corner. Medicare Changes in 2011: Apr - Jun, 2011
• Legislative Corner. About H.R. 4662 2010: Jan - Mar, 2011
• Medicare at a Threshold Part 3. Lobby Trip, NLN IAC, Bill Changes: Oct - Dec, 2010
• Medicare at a Threshold Part 2. Update Lymphedema Bill 2010: Jul - Sep, 2010
• Medicare at a Threshold Part 1. MEDCAC, Coding, Denials: Apr - Jun, 2010
• Legislation Update: Medicare MEDCAC, Pump Claims Coding: Jan - Mar, 2010
• Lymphedema Insurance and Legislation Update. NC Law: Oct - Dec, 2009
• Lymphedema Insurance and Legislation Update. State Bills NY, NC, MA Jul - Sep, 2009
• Lymphedema Insurance and Legislation Update. NY Bills Apr - Jun, 2009
• Lymphedema Insurance and Legislation Update. Grass Roots Advocacy Jan - Mar, 2009
• Lymphedema Insurance and Legislation Update. New York Bills Oct - Dec, 2008
• Lymphedema Insurance and Legislation Update. State Bills Jul - Sep, 2008
• Lymphedema Insurance and Legislation Update. Apr - Jun, 2008
• Groundbreaking Medicare Appeals Council Decision. Feb 2008
• Lymphedema Insurance and Legislation Update. 75% Rule, Medicare Denials: Jan - Mar, 2008
• Legislation Update. NJ Resolution & NY Lymphedema Bill: Oct - Dec, 2007
• Summary of State Lymphedema Bills. Jul - Sept, 2007
• Therapy Caps Exception Process 2007. Repeal of Caps & Garment Non-Coverage: Apr – Jun, 2007
• Medicare Coverage of Compression Items: Jan - Mar, 2007
• Progress on the Medicare Coverage Front: Oct - Dec, 2006
• 2006 Mid-Year Lymphedema Legislation Update: Jul – Sep 2006
• Lymphedema Legislative Update (As of Feb 15, 2006): Apr – Jun, 2006
• Lymphedema Legislative Summary (As of Nov 22, 2005): Jan – Mar, 2006
• Legislative Update State Bills & Resolutions: Apr – Jun 2005
• Lymphedema Legislative Summary May 2004 Federal & State Bills: Jul - Sep 2004

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Lymphedema Insurance & Legislation Update: Apr-June 2009

 By Robert (Bob) Weiss, MS, LE Legislative Advocate

Last year the New York State Assembly unanimously approved A05892B Maisel , a bill which has many provisions which fall squarely within the NLN’s mission “to create awareness of lymphedema through education and to promote and support the availability of quality medical treatment for all individuals at risk for or affected by lymphedema”: The New York Senate version of this bill S03248B Fuschillo never left the Senate Rules Committee. The two bills have been re-introduced in the 2009-10 legislative session as A05320 Maisel/S00629 Fuschillo. These are the only lymphedema bills among the seven thus far reintroduced which seem to have a chance of passing this session.

• Section 1 adds the requirement for the Health Department to investigate causes, treatment, facilities, and prevention of lymphedema to its existing requirements relating to cancer;

• Section 2 adds reporting of all diagnosed cases of cancer-related lymphedema. Currently there are no reliable and authoritative statistics on the prevalence of lymphedema in New York State. This information is urgently needed by legislators and insurers to understand how large is the affected population;

• Section 3 provides an important breast cancer patient protection (duty to inform) which is currently the law, but which is not generally practiced with respect to information relating to risk of lymphedema for each treatment option;

• Section 4 provides the same protection as Section 3 to the prostate cancer patient adding duty to inform of risk of lymphedema for each treatment option;

• Section 5 adds primary and secondary lymphedema, lymphatic disease, lipedema, and vascular disease to the existing list of childhood medical conditions in the definition of “children with physical disabilities”;

• Section 6 adds lymphedema and lymphatic diseases to the healthcare and wellness education and outreach program of the NY Department of Health. The NLN has already assisted the NY Health Commissioner with a brochure on lymphedema following breast cancer treatment.

Other lymphedema bills reintroduced into the New York Legislature as of February 13, 2009 are:

* A02862 Kolb Requires insurance policy providers to provide coverage for the diagnosis and treatment of lymphedema, including the costs of compression sleeves

* A05321 Maisel Creates the lymphedema and lymphatic diseases research grants program

* A05322 Maisel Creates the lymphedema and lymphatic diseases research and education fund

* A05324 Maisel Requires health insurance coverage for lymphedema, patient informed consent, therapist qualification requirements, patient protection, compression garments, and extends the lymphedema treatment protections of the Federal Women’s Health and Cancer Rights Act of 1998 to private insurance.

* A05388 Maisel Requires physicians to report cases of lymphedema to the department of health and creates the lymphedema and lymphatic diseases registry and advisory board.

As for the other states which have had lymphedema treatment and garment mandate bills in past sessions (CA, MA, GA, CT) none have been re-introduced as of February 13.

For the score keepers among my readers, during December 2008 and January 2009 we won four reversals of Medicare denials of compression garments in ALJ hearings, bringing the total in the last few years to 12 claims with fully- or partially-satisfactory outcomes involving nine ALJs from 3 HHS appeal centers. More and more ALJs are agreeing with the medico-legal argument that compression garments are reasonable and medically necessary in the treatment of lymphedema, and that the garments are covered by Medicare as a prosthetic device benefit according to §1861(s)(8) of the Social Security Act. I wish to thank the physicians from the NLN Medical Advisory Committee who have provided expert medical testimony at these hearings.

Robert "Bob" Weiss, M.S.
NLN LE Legislative Advocate

 

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