WOCN SCORES ADVOCACY SUCCESSES IN 117TH CONGRESS

WOCN successfully advocated for the inclusion of two important Congressional policy priorities at the end of 2022. Both The Lymphedema Treatment Act and The Better Wound Care at Home Act were included in this last legislative vehicle to move in the 117th Congress and were signed into law before the end of the year. Both pieces of legislation have been WOCN advocacy priorities for several sessions of Congress and we are thrilled they have been enacted. The proposed rule outlining how each of these new policies will be implemented is expected to be issued by CMS sometime in June.

 

THE LYMPHEDEMA TREATMENT ACT

This important legislation would amend Medicare statute to pay for compression garments, bandages and supplies to reduce lymphedema-related swelling and prevent recurrence. WOCN has been working with the Alliance for Wound Care Stakeholder to ensure that CMS implements the best benefit possible. The first step in this process was a call we had with the CMS staff in April who will be responsible for creating the compression benefit. WOCN joined with other Alliance clinical groups to present best practices for lymphedema treatment as well as a comprehensive discussion of what products are used for treatment and how products are fitted. In addition, the Alliance sent a more detailed written document explaining in greater detail the following items:

  • Treatment of lymphedema from initiation to maintenance
  • Other diagnostic considerations- e.g., phlebolymphedema
  • Maintenance and fitting of the compression items
  • What is involved with the measure, fit and application of bandages and compression items
  • Input on types of items necessary to treat lymphedema in addition to compression garments
  • Expected timeframes these items last and how often they should be replaced
  • Recommendation that CMS establish HCPCS or CPT codes along with coverage and payment for the following:
      • CPT procedure codes specific for measuring, fitting and education related to compression garments. Currently there are not skill specific CPT codes for medical providers, allied health and/or fitters to account for the time and expertise required to fit/measure/provide these compression items.
      • HCPCS codes for efficacy aids named above as well as custom compression garments for all body parts.

 

THE BETTER WOUND CARE AT HOME ACT

This policy change would put disposable durable medical equipment, such as the commonly used negative pressure wound therapy (NPWT) device, on a level playing field with non-disposable NPWT devices giving home care providers more flexibility on how to treat their patients. The language passed Congress in December 2022 would clarify existing policy on disposable “DME” and should smooth implementation of this benefit and encourage home health agencies to use the device as another treatment option. Specifically, the new policy:

  • Clarifies that payment for disposable NPWT is for the technology only, as intended by the original legislation, and not for both the technology and related service of its application
  • Eliminates the requirement that home health agencies use a separate billing form for providing disposable NPWT
  • Removes the duplicative requirement that nurses separately report their time for furnishing disposable NPWT