H.R. 3630 — what changed
Lymphedema Treatment Act
From Reported in House to Engrossed in House. 1 section amended and 2 added between Reported in House and Engrossed in House.
Sec. 2 Medicare coverage of certain lymphedema compression treatment items
“(II) lymphedema compression treatment items (as defined in subsection (lll));”
“(lll) Lymphedema compression treatment items—The term lymphedema compression treatment items means standard and custom fitted gradient compression garments and other items determined by the Secretary that are—
“(1) furnished on or after January 1, 2024, to an individual with a diagnosis of lymphedema for the treatment of such condition;
“(2) primarily and customarily used to serve a medical purpose and for the treatment of lymphedema, as determined by the Secretary; and
“(3) 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).”
“(z) Payment for lymphedema compression treatment items
“(1) In general—The Secretary shall determine an appropriate payment basis for lymphedema compression treatment items (as defined in section 1861(lll)). 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.
“(2) Frequency limitation—No payment may be made under this part for lymphedema compression treatment items furnished other than at such frequency as the Secretary may establish.
“(3) Application of competitive acquisition—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)—
“(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
“(B) 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.”
“(D) Lymphedema compression treatment items—Lymphedema compression treatment items (as defined in section 1861(lll)) for which payment would otherwise be made under section 1834(z).”
“(iv) Lymphedema compression treatment items (as defined in section 1861(lll)).”
“(E) lymphedema compression treatment items (as defined in section 1861(lll));”
Sec. 3 Medicare Improvement Fund
addedadded Section 1898(b)(1) of the Social Security Act (42 U.S.C. 1395iii(b)(1)) is amended by striking “$7,308,000,000” and inserting “$6,738,000,000”.
Sec. 4 Determination of budgetary effects
addedadded The budgetary effects of this Act, for the purpose of complying with the Statutory Pay-As-You-Go Act of 2010, shall be determined by reference to the latest statement titled “Budgetary Effects of PAYGO Legislation” for this Act, submitted for printing in the Congressional Record by the Chairman of the House Budget Committee, provided that such statement has been submitted prior to the vote on passage.