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THE NEBRASKA HEALTH INSURANCE INFORMATION, COUNSELING, AND ASSISTANCE (NICA) PROGRAM

SEPTEMBER 2001 NICA NEWS

CHANGES

Medicare to Expedite Coverage for Lymphedema Pumps

HHS Secretary Tommy G. Thompson announced recently that Medicare will expedite coverage of pneumatic compression pumps to make it easier for Medicare beneficiaries with lymphedema to take advantage of the technology.

Medicare's new coverage policy eliminates language that made these compression pumps the treatment of "last resort" for beneficiaries suffering from lymphedema, an accumulation of lymphatic fluid causing abnormal swelling of the arms, legs, breast, neck or head that often develops when lymph nodes are removed during surgery. Breast cancer surgery is the most common cause of the condition in the United States.

Under the new coverage policy, Medicare will cover the pump if a beneficiary first undergoes an initial therapy of conservative care, which includes elevation, exercise and the use of a compression garment, for at least four weeks without results. The new policy eliminates the need for a Medicare beneficiary to purchase a more expensive, custom-made garment before being eligible to receive a pump.

Although lymphedema is not life threatening, it can significantly impact the quality of life for sufferers. The condition can be uncomfortable and painful, as well as disfiguring and disabling. In some cases it can lead to cellulitis or lymphangitis.
HHS May 3, 2001 Press Release

More about the Benefit Improvements and Protection Act (BIPA) of 2000

There are a few provisions of the BIPA legislation that have been put in place recently or are scheduled to be implemented in the next few months:

Temporary Increase for Home Health Services Provided in a Rural Area: Medicare payments were increased as of April 1, 2001 for home health services furnished in certain rural areas for the next two years.

Coverage of Biennial Screening Pap Tests: Effective July 1, 2001, Medicare began covering screening pap tests and pelvic exams every two years. Previously it was covered every three years.

Restoring Effective Date of Elections and Changes of Elections of Medicare+Choice Plans: Effective June 1, 2001 this provision allows individuals to enroll or disenroll any time during the month and the change will be effective the first day of the next month. Prior to the change, beneficiaries had to make the change by the 10th of the month for it to be effective the first of the next month.

Waiver of 24-Month Waiting Period for Medicare Coverage for Persons Disabled with Lou Gehrig's Disease (ALS): Effective July 1, 2001, this provision waives the 24-month waiting period (otherwise required for an individual to establish Medicare eligibility on the basis of a disability) for persons medically determined to have ALS.

Coverage of Screening Colonoscopy for Average Risk Individuals: Effective July 1, 2001, Medicare began covering screening colonoscopies for all individuals, not just those at high risk.

HCFA Undergoes Name Change and Reform

HHS Secretary Tommy G. Thompson announced the first wave of efforts to reform and strengthen the services and information available to nearly 70 million Medicare and Medicaid beneficiaries and the health care providers who serve them.

As part of that effort, Secretary Thompson unveiled the new name for the agency - the Centers for Medicare & Medicaid Services (CMS), formerly known as the Health Care Financing Administration (HCFA). The new name reflects the increased emphasis on responsiveness to beneficiaries and providers, and on improving the quality of care that beneficiaries receive. To achieve these goals, the Centers for Medicare & Medicaid Services will:

launch a national media campaign to give beneficiaries more information to help them make informed decisions about how they want to get their health care;
instill a new culture of responsiveness in serving beneficiaries, physicians and other health care providers, states and lawmakers;
enhance 1-800-MEDICARE to a 24-hour a day, seven days a week service that will provide far more detailed information;
reform the contractor process to improve the quality and efficiency of the Medicare claims processing services.
restructure the agency around three centers that reflect the agency's major lines of business;

The three new business centers being created as part of the reforms are the Center for Beneficiary Choices, the Center for Medicare Management, and the Center for Medicaid and State Operations.
-- Taken in part from the 6/14/01 HHS Press Release CMS