[Congressional Bills 117th Congress]
[From the U.S. Government Publishing Office]
[H.R. 3630 Referred in Senate (RFS)]
<DOC>
117th CONGRESS
2d Session
H. R. 3630
_______________________________________________________________________
IN THE SENATE OF THE UNITED STATES
November 17, 2022
Received; read twice and referred to the Committee on Finance
_______________________________________________________________________
AN ACT
To amend title XVIII of the Social Security Act to provide for coverage
of certain lymphedema compression treatment items under the Medicare
program.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Lymphedema Treatment Act''.
SEC. 2. MEDICARE COVERAGE OF CERTAIN LYMPHEDEMA COMPRESSION TREATMENT
ITEMS.
(a) Coverage.--
(1) In general.--Section 1861 of the Social Security Act
(42 U.S.C. 1395x) is amended--
(A) in subsection (s)(2)--
(i) in subparagraph (GG), by striking
``and'' after the semicolon at the end;
(ii) in subparagraph (HH), by striking the
period at the end and inserting ``; and''; and
(iii) by adding at the end the following
new subparagraph:
``(II) lymphedema compression treatment items (as defined
in subsection (lll));''; and
(B) by adding at the end the following new
subsection:
``(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).''.
(2) Payment.--
(A) In general.--Section 1833(a)(1) of the Social
Security Act (42 U.S.C. 1395l(a)(1)) is amended--
(i) by striking ``, and'' before ``(EE)'';
and
(ii) by inserting before the semicolon at
the end the following: ``, and (FF) with
respect to lymphedema compression treatment
items (as defined in section 1861(lll)), 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)''.
(B) Payment basis and limitations.--Section 1834 of
the Social Security Act (42 U.S.C. 1395m) is amended by
adding at the end the following new subsection:
``(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.''.
(3) Conforming amendment.--Section 1847(a)(2) of the Social
Security Act (42 U.S.C. 1395w-3(a)(2)) is amended by adding at
the end the following new subparagraph:
``(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).''.
(b) Inclusion in Requirements for Suppliers of Medical Equipment
and Supplies.--Section 1834 of the Social Security Act (42 U.S.C.
1395m) is amended--
(1) in subsection (a)(20)(D), by adding at the end the
following new clause:
``(iv) Lymphedema compression treatment
items (as defined in section 1861(lll)).''.
(2) in subsection (j)(5)--
(A) by redesignating subparagraphs (E) and (F) as
subparagraphs (F) and (G), respectively; and
(B) by inserting after subparagraph (D) the
following new subparagraph:
``(E) lymphedema compression treatment items (as
defined in section 1861(lll));''.
SEC. 3. MEDICARE IMPROVEMENT FUND.
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.
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.
Passed the House of Representatives November 17, 2022.
Attest:
CHERYL L. JOHNSON,
Clerk.