Lymphedema Compression Treatment Items

Starting January 1, 2024, Medicare will pay for lymphedema compression treatment items for Medicare Part B patients.

What’s Covered?

We’ll pay for standard and custom-fitted lymphedema compression treatment items for each affected body part, including:

• Compression garments, including those for daytime and nighttime, which offer different levels of compression
• Compression bandaging systems and supplies provided during the initial decongestion phase and maintenance phases of treatment
• Gradient compression wraps with adjustable straps
• Necessary accessories for gradient compression garments and wraps, including:
• Aids for putting on and taking off (donning and doffing) items for different body parts, like lower limb butlers or foot slippers that help patients put on compression stockings
• Fillers
• Lining
• Padding
• Zippers

How Often?

We pay for compression garments:

• Daytime: 3 garments every 6 months
• Nighttime: 2 garments every 2 years

We also pay for items, as needed:

• To replace lost, stolen, or irreparably damaged items
• If a patient’s condition changes, like a change in limb size

Who’s Eligible?

We’ll pay for these treatment items when:

• The patient has Medicare Part B coverage (their annual Part B deductible and 20% coinsurance will apply)
• The patient has lymphedema (a chronic condition that causes swelling in the body's tissues) and will use the item to primarily and customarily treat it
• An authorized practitioner prescribes the item

Can I Furnish These Items?

You must be an enrolled DMEPOS supplier to get Medicare payment for furnishing these treatment items. Become a DMEPOS supplier.

What Are My Responsibilities?

When you furnish a lymphedema compression treatment item, you’re responsible for all aspects of providing the item, unless you work out an arrangement with a professional fitter to perform the services. This includes:

• Taking measurements of the patient’s affected body area
• Performing necessary fitting services
• Training the patient how to take the treatment item on and off
• Showing the patient how to take care of the treatment item
• Adjusting the treatment item, if needed

How Can I Bill?

Starting January 1, use new and existing codes in the January 2024 Alpha Numeric HCPCS File. We’ll publish the January file soon.

Where Can I Get More Information?

• Final Rule
• Section 4133 of the Consolidated Appropriations Act (CAA)
• Section 1834(j) of the Act

‘Worse Than People Can Imagine’: Medicaid ‘Unwinding’ Breeds Chaos in States

KFF Health News | By Phil Galewitz, Katheryn Houghton, Brett Kelman and Samantha Liss

More than two dozen people lined up outside a state public assistance office in Montana before it opened to ensure they didn’t get cut off from Medicaid.

Callers in Missouri and Florida reported waiting on hold for more than two hours on hotlines to renew their Medicaid coverage.

The parents of a disabled man in Tennessee who had been on Medicaid for three decades fought with the state this summer to keep him enrolled as he lay dying from pneumonia in a hospital.

Seven months into what was predicted to be the biggest upheaval in the 58-year history of the government health insurance program for people with low incomes and disabilities, states have reviewed the eligibility of more than 28 million people and terminated coverage for over 10 million of them. Millions more are expected to lose Medicaid in the coming months.

The unprecedented enrollment drop comes after federal protections ended this spring that had prohibited states from removing people from Medicaid during the three pandemic years. Since March 2020, enrollment in Medicaid and the related Children’s Health Insurance Program had surged by more than 22 million to reach 94 million people.

The process of reviewing all recipients’ eligibility has been anything but smooth for many Medicaid enrollees. Some are losing coverage without understanding why. Some are struggling to prove they’re still eligible. Recipients and patient advocates say Medicaid officials sent mandatory renewal forms to outdated addresses, miscalculated income levels, and offered clumsy translations of the documents. Attempting to process the cases of tens of millions of people at the same time also has exacerbated long-standing weaknesses in the bureaucratic system. Some suspect particular states have used the confusing system to discourage enrollment.

“It’s not just bad, but worse than people can imagine,” said Camille Richoux, health policy director for the nonprofit Arkansas Advocates for Children and Families. “This unwinding has not been about determining who is eligible by all possible means, but how we can kick people off by all possible means.”

To be sure, some of the Medicaid recipients who signed on to the program when the U.S. unemployment rate soared amid covid-19 lockdowns have since gotten health insurance through new jobs as unemployment dropped back to pre-pandemic lows.

And some of the disenrolled are signing up for Affordable Care Act marketplace plans. Centene CEO Sarah London, for example, told investors on Oct. 24 that the health care giant expected as many as 2.4 million of its 15 million Medicaid managed care members to lose coverage from the unwinding, but more than 1 million customers had joined its exchange plans since the same time last year.

Still, it’s anyone’s guess how many former Medicaid beneficiaries remain uninsured. States don’t track what happens to everyone after they’re disenrolled. And the final tallies likely won’t be known until 2025, after the unwinding finishes by next summer and federal officials survey Americans’ insurance status…

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CDC Launches Initiative to Reduce Healthcare Worker Burnout

Modern Healthcare | By Mari Devereaux
 
The Centers for Disease Control and Prevention is launching an effort to help hospitals address workforce burnout and support the mental wellness of their employees.
 
Led by the CDC’s National Institute for Occupational Safety and Health and the Dr. Lorna Breen Heroes Foundation, the initiative includes resources for hospitals to identify areas for improvement in employee well-being and training for frontline leaders to help foster a better work-life balance among staff.
 
“Many of the current approaches [to burnout] have been directed at individual health workers, asking them to become more resilient, as opposed to changing the environment where these stressors are actually occurring,” said Dr. Casey Chosewood, director of the Office for Total Worker Health, part of the National Institute for Occupational Safety and Health.
 
Around 56% of nurses and 47% of physicians reported burnout during the COVID-19 pandemic, according to an American Medical Association survey of more than 43,000 healthcare professionals published in March by the Journal of General Internal Medicine.
 
Industrywide issues like inadequate staffing, increased clinical workload and negative employer-employee relations remain the primary causes of burnout among healthcare workers, leading more to unionize or announce their intentions to leave healthcare. 
 
The initiative will focus on offering health systems long-term solutions to widespread burnout and suggesting changes to policies, workflows and systems of mental health support, Chosewood said. Another component is a worker well-being questionnaire that hospitals could use to determine the main struggles at their institution.
 
The initiative builds on a 2021 CDC campaign to raise awareness of the mental health burden of clinicians and educate industry leaders on best practices, policies and interventions to prevent burnout.
 
A number of healthcare worker advocacy organizations have sounded the alarm on clinician burnout, and there have been some legislative efforts to address the issue with funding.

In 2022, President Joe Biden signed the Dr. Lorna Breen Health Care Provider Protection Act, which allotted $135 million over three years to hospitals and the Health and Human Services Department to encourage mental health treatment and prevent suicide among healthcare workers. About $20 million from the law, funded by the American Rescue Plan Act, went to the institute to fund research and other work in the clinician mental health space, Chosewood said.

Home Health Final Rule: Clinical & Financial Strategies for Success in 2024

Wednesday, November 8 | 1:30 - 2:30 p.m. EST

Join McBee and Associates hosts Jeff Aaronson, Vice President of Advisory Consulting, and Lisa Selman-Holman, Vice President of Education & Quality, as they give their key takeaways from the final rule. They will also share strategies for clinical and financial success moving forward.

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