IMPORTANT NOTICE WHICH MAY CHANGE YOUR ACCESS TO LYMPHEDEMA SERVICES IN 2014

IMPORTANT NOTICE WHICH MAY CHANGE YOUR ACCESS TO LYMPHEDEMA SERVICES IN 2014

WE HAVE ONLY UNTIL SEPT 4, 2012, TO RESPOND TO THIS!!  It is up to us to have our voices heard VERY loudly on this. 

Medicare Part B

CLAIMS-BASED DATA COLLECTION STRATEGY FOR THERAPY SERVICES PROPOSED

CMS issued proposed rule, CMS1590P, on July 6 that includes a proposal to collect data on patient function related to physical and occupational therapy, and speech language pathology services. Section 3005(g) of the Middle Class Tax Relief and Jobs Creation Act (MCTRJCA) requires CMS to implement, beginning on January 1, 2013, ". . . a claims based data collection strategy that is designed
to assist in reforming the Medicare payment system for outpatient therapy services subject to the limitations of section 1833(g) of the Act.

Such strategy shall be designed to provide for the collection of data on patient function during the course of therapy services in order to better understand patient condition and outcomes."

The proposed appeared in the July 30, 2012 Federal Register. CMS will accept comments on the proposed rule until September 04, 2012, and will respond to them in a final rule with comment period to be issued by November 1, 2012.

The Problem:
1. New non-payable data collection codes for reporting functional limitations for each claim;
2. Goal is new therapist reimbursement based on improvement of function and complexity of services;
3. Proposed criteria for evaluating improvement of functional limitations are all physical measures There are no measures proposed that would measure
lymphedema severity or improvement of lymphatic function;

Action:

Write a letter to CMS pointing out the impact the new rule will have to you, as a lymphedema patient, if there are no quality measures appropriate to describe the severity/complexity of the “functional limitation” of lymphedema, and
therefore neither the severity/complexity of the functional limitation, nor the progress attained by the therapist. This lack of means of describing and
evaluating the improvement achieved by lymphedema therapy could result in the
incorrect conclusion that the therapy is of no medical value and disapproved.

To be assured consideration, comments must be received at one of the addresses provided below, no later than 5 p.m. on September 4, 2012.

ADDRESSES: In commenting, please refer to file code CMS–1590–P. Because of staff and resource limitations, we cannot accept comments by facsimile (FAX) transmission. You may submit comments in one of four ways (please choose only
one of the ways listed):

1. Electronically. You may submit electronic comments on this regulation to regulations
http://www.regulations.gov. Follow the instructions for ``submitting a comment.''

2. By regular mail. You may mail written comments to the following address ONLY:
Centers for Medicare & Medicaid Services, Department of Health and Human
Services, Attention: CMS–1590–P, P.O. Box 8013, Baltimore, MD 21244–8013.

Please allow sufficient time for mailed comments to be received before the close
of the comment period.

3. By express or overnight mail. You may send written comments to the following address ONLY: Centers for Medicare & Medicaid Services, Department of Health and Human Services, Attention: CMS–1590–P, Mail Stop C4–26–05, 7500 Security Boulevard, Baltimore, MD 21244–1850.

4. By hand or courier. If you prefer, you may deliver (by hand or courier) your written comments before the close of the comment period to either of the
following addresses:

a. For delivery in Washington, DC— Centers for Medicare & Medicaid Services,
Department of Health and Human Services, Room 445–G, Hubert H. Humphrey
Building, 200 Independence Avenue SW., Washington, DC 20201. (Because access to
the interior of the Hubert H. Humphrey Building is not readily available to persons without Federal government identification, commenters are encouraged to leave their comments in the CMS drop slots located in the main lobby of the building. A stamp-in clock is available for persons wishing to retain a proof of filing by stamping in and retaining an extra copy of the comments being filed.)

b. For delivery in Baltimore, MD— Centers for Medicare & Medicaid Services,
Department of Health and Human Services, 7500 Security Boulevard, Baltimore, MD
21244–1850. If you intend to deliver your comments to the Baltimore address, please call telephone number (410) 786– 7195 in advance to schedule your arrival with one of our staff members. Comments mailed to the addresses indicated as appropriate for hand or courier delivery may be delayed and received after the comment period.

Robert Weiss, M.S.
Lymphedema Patient Advocate
National Lymphedema Network

Lymphedema - Medicare - What You Can Do

Lymphedema - Medicare - What You Can Do
I'd like to start everyone off with the following three steps. Take on as much as you all can but don't over-do. I know we all have limited time and energy. The first thing to do is to get your lymphedema under control, then we can start educating and lobbying.

1. If you have recently been denied compression bandages, garments or devices, and you are still within the time period for an appeal, let's get the appeal going. I'll supply the proper forms and help you fill them out. If you have paid for compression materials and have not been formally denied, I'll send you a Medicare claim form. Otherwise I'll help you write a claim letter.

2. I must also know whether you wish to work towards national Medicare legislation or State legislation for the diagnosis and treatment of lymphedema.

Tell me your 9-digit ZIP code and I'll tell you the name and contact info for your legislators with suggestions as to the best ones to contact.

3. When you have some spare time, call your legislators to urge them to support (or introduce) legislation which affects your ability to access quality lymphedema care. Some current bills are as follows:

Stopgap legislation has been introduced in both the Senate and House (S. 543 Nelson/H.R. 1459 Tanner) that would freeze implementation of 75% Rule and prevent additional access problems for individuals requiring lymphedema treatment.

The House recently passed the Children's Health and Medicare Protection (“CHAMP”) Act of 2007, which includes a freeze in the implementation of the 75% Rule at the 60% threshold indefinitely.

The legislation would also allow patients' co-morbidities to continue to be considered for purposes of meeting the 75% Rule quota.

In March 2005 CMS changed their interpretation of the Social Security Act to limit coverage of manual lymph drainage to physical and occupational therapists, thereby eliminating coverage of treatment by specially-qualified nurses, physicians, osteopaths, chiropractors and massage therapists.

This effectively reduced the numberof available trained therapists by some 30 percent. A number of lymphedema treatment clinics around the country have already been forced to close as a result of this policy change. H.R. 1846 Towns attempts to partially rectify this ill-advised policy by restoring physician authority in selecting qualified medical personnel to perform “incident to” services.

Also in March 2006 lymphedema was exempted automatically from therapy caps that were re-imposed on January 1, 2006. But in January 2007 exemption was made dependent on existence of a co-condition. This constitutes another roadblock to access to physician-prescribed treatment for lymphedema patients.

S. 450 Ensign/H.R. 748 Becerra would permanently eliminate therapy caps.

Thanks for helping.

BobRobert Weiss, M.S.Lymphedema Treatment Advocate

Email: LymphActivist@aol.com