“The Medicare rules are about to change substantially regarding coverage for pneumatic compression devices for US citizens with lymphedema and chronic venous insufficiency. This is very troubling news.”
Thus began our discussion with Jonathan Ross, President of Bio Compression Systems, Inc., a U.S. manufacturer of pneumatic compression devices. Mr. Ross is passionate about this issue and deeply concerned about the effect these changes will have on lymphedema patients. We asked him to explain what is happening.
New Local Coverage Determinations (LCDs) are being put in place for all four Medicare regions that will overwrite the National Coverage Determinations (NCDs) that are currently in place for pneumatic compression devices. While a LCD should never restrict a NCD, the new policy does just that. Below are some highlights of the changes that are scheduled to go into effect on November 1, 2014:
• Patients will now have to live with a “documented persistence over a period of at least six months of ‘chronic and severe’ lymphedema” before they can qualify for a pump as compared to the current rule which asks for a 4-week trial of conservative therapy only.
• There is a new requirement that a patient must get manual lymphatic drainage (MLD) therapy for 4 weeks prior to getting a pump. This places undue burden on patients, particularly those who must travel many hours and at great expense to see a therapist.
• All patients, regardless of need, will now be required to take medication before qualifying for a pump.
• Under these new rules, if patients see “any improvement” during the 4-week treatment period, they will be disqualified from getting a pump.
• Podiatrists can no longer prescribe pumps, even though Podiatrists are defined as physicians under the Affordable Care Act.
These are highlights. We will provide more information and further updates on this development over the next few weeks.
“We are asking people to reach out to their representatives and fight this change in coverage policy. It is outrageous and will absolutely hurt the American population who lives every day with lymphedema,” said Mr. Ross. He urges concerned citizens to make their voices heard at www.defendcompressioncoverage.org.