CVI
and Lymphedema Patient Rights Bill
Part
One
Pages One through Four
As Written By: Cheri Hoskins (Healthtronix) and Cyndi Ortiz (Nevada Lymphatic and Cascular)
10/30/04
Definitions:
“Health Insurer” means
any company, organization, private entity, self-funded entity, or
government
agency (Medicare and Medicaid and administrators thereof), health
maintenance
organizations, and private insurance companies contracted to provide
health care
coverage for Medicare recipients, Veterans Administration, United
States
Military, CHAMPUS or any entity that provides or represents itself as
providing
assistance for coverage for health care expenses.
“Lymphedema”
means a
disease in which the lymph system is not functioning correctly or is
blocked,
causing one or more parts of the body to become chronically edematous.
This law
defines Lymphedema as
being caused by a congenital or hereditary defect, removal of lymph
nodes,
surgical interruption, radiation, or unknown cause.
“Chronic”.
This
law defines
chronic as one or more signs
or symptoms,
edema, hyperpigmentation, or
wounds, being present for six months or more.
“Chronic Venous
Insufficiency” means a disease of the veins in which blood return to
the heart
is not sufficient. This
law lists
the symptoms of venous insufficiency as chronic edema,
hyperpigmentation, stasis
dermatitis, and pain.
“Peripheral Vascular
Disease” means an abnormal condition of the blood vessels outside the
heart
and lymph vessels. This law lists the symptoms of peripheral vascular
disease as
numbness, pain, hyperpigmentation, elevated blood pressure, and
impaired
arterial pulsations.
“External Compression”
means various forms of external compression modalities.
“Manual Lymph Drainage or
MLD” means manipulative physical therapy technique that assists in
opening
pathways for lymph to flow.
“Combined Decongestive
Therapy or “CDT” means and or includes manual lymph drainage, gradient
bandaging, remedial exercises, circumferential measurements,
nutritional
instructions, and instructions on proper skin care.
“Certified Lymphedema Therapists” means a licensed physical therapist, occupational therapist, message therapist, registered nurse, or licensed practical/vocational nurse who has received at least 135 hours of training specific to lymphatic and vascular disease, manual lymph drainage, and combined decongestive therapy by an independent certification entity or agency.
"Treating Physician" A Physcian or Medical Doctor, Physician's Assistant, or Podiatrist who is treating the patient for lymphatic and/or vascular disease.
“Provider” means a
provider of therapy, supplies, and equipment.
“DME Provider” means a
provider of durable medical equipment.
“Patient” means a
person, male or female, who has been diagnosed by a physician upon
physical
examination with chronic venous insufficiency, lymphedema, or
peripheral
vascular disease.
“Treatment” means effectively treating lymphedema, chronic venous insufficiency, and peripheral vascular disease utilizing available treatment and management modalities as recommended by the treating physician.
“Disease Management ” means effectively managing lymphedema, chronic venous insufficiency, and peripheral vascular disease, utilizing available treatment and management modalities as recommended by the treating physician, in such a way that will create patient independence, and treatment success.
“Specialize or Specialty” means a person or company
or health care
entity whose primary function is offering treatment, supplies, or
equipment
specific to chronic venous insufficiency, lymphedema, or chronic venous
insufficiency.
“Home
Disease Management Program ” means a disease management program,
specific to each
patient’s needs, that will
ensure that a patient is able to successfully treat and manage their
disease
independently at home for the remainder of their life.
“Certified Compression
Therapist” means a
person
specializes and is certified to provide external compression items,
supplies and
devices. A
Certified Compression
Therapist is trained in disease etiology of lymphatic and vascular
disease,
treatment available, all aspects of external compression
specific to
lymphatic and vascular disease, disease complications,
contraindications of
external compression modalities, effective disease management,
conducting
evaluations and need assessment, measurements, evaluating treatment
progress,
basic wound care, and basic knowledge of other treatment modalities
available
and related to lymphatic and vascular disease.
The nature of this law is to
protect patient rights, assist patients with these diseases in
obtaining proven
effective treatment, avoiding inappropriate denials and delays in
treatment by
health insurers, improving the quality of health care, and improving
the ability
of the patient and physician to determine treatment course. These
diseases are
separate diseases of separate systems, while some are seen concurrent,
they are treated in much the same way. These diseases are all chronic,
and
currently there is no cure. This
law is
designed to set a standard for effective disease treatment,
management, thus reducing the cost of healthcare.
This law shall ensure
coverage for early intervention, treatment, and management of lymphatic
and
vascular diseases. Health insurers shall cover and provide for their
beneficiaries at least,
but not limited to,
the following:
Qualifying
Factors:
Lymphedema: Any
person who has been diagnosed upon a physical examination by their
physician
with lymphedema.
Chronic Venous
Insufficiency: Any person who has been diagnosed upon a physical
examination by
their physician with chronic venous insufficiency.
Peripheral Vascular Disease:
Any person who has been diagnosed upon a physical examination by their
physician
with peripheral vascular disease.
Therapy:
Physical Therapy for lymphatic and vascular disease, including MLD and CDT shall be considered medical services for disease management and prevention, and not physical or occupational therapy.
Certified Compression Therapists:
Shall be considered disease management specialists and not limited to durable medical equipment provisions to allow for reimbursement for evaluations, proper set-up and patient education, follow-up evaluations.
Lymphedema
Management
Program which shall consist of
:
Early
intervention
shall include coverage for consult and education with a Certified
Lymphedema
therapist when the treating Oncologist
has a reasonable expectation of cancer treatment consisting of lymph
node
removal and/or radiation for both males and females. The Certified
Lymphedema
therapist is to provide those anticipating being treated for cancer
with lymph
node removal and/or radiation with education and information on
lymphedema,
signs and symptoms to watch for, and treatments options. Management
shall
include a second consult and follow-up with a Certified Lymphedema
therapist within three months of the cancer treatment, which included
lymph node removal
and/or radiation. This
second
consult shall include a review of information provided during the
initial
consultation.
Treatment
shall
include but are not limited to coverage for:
Mild
to Moderate shall allow thirty physical therapy visits to include,
but not limited to,
treatment of MLD/CDT and application of external compression, patient
education, and
home management discharge planning.
Moderate
to Severe shall allow for ninety visits of physical therapy visits to
include,
but not limited to initial evaluation, treatment of MLD and application
of
external compression, patient education, home management discharge
planning.
Coverage shall include treatment for all effected areas.
Follow-Up
shall
include but are not limited to coverage for:
Follow-up
or management visits with a lymphedema specialist once every six months
for the
remainder of the patient’s lifetime. This visit is designed to assist
the
patient in continuing their home management program, adjusting it as
needed, and
keeping patients updated on new treatment options.
External
compression
shall include but is not limited to coverage any item needed to achieve
effective external compression as ordered by the treating physician.
These items
include, but are not limited to, graduated compression stockings,
custom
fabricated compression stockings, multilayered compression bandaging,
external
compression binders, and directional flow garments. Coverage for
external
compression pumps shall include gradient calibrated sequential
compression pumps
in which the garments consist of eight or more chambers, when ordered
by the
treating physician. Coverage shall include treatment for all affected
areas of
the body. Mechanical pumps which consist of calibrated gradient,
sequential
compression, with mechanical MLD mechanism shall be covered when
ordered by the
treating physician.
Podiatric
Intervention and Footcare shall
be covered monthly for toenail care for lymphedema patients when the
lower
extremity is affected.
Chronic
Venous Insufficiency and Peripheral Vascular Disease Management Program
which shall
consist of but is
not limited to:
Early
Intervention
shall include coverage for compression stockings, and custom fabricated
compression stockings, physical therapy and other external compression
items and
devices as ordered by the treating physician when the patient has been
diagnosed with chronic venous
insufficiency or peripheral vascular disease.
External
Compression shall
include, but is not limited to coverage of compression stockings,
custom
fabricated compression stockings, external compression binders, Foam
compression
binders, Gradient Foam Compression Binders with pressure gauge,
compression
bandaging, multi layered compression bandaging, and directional flow
garments.
All external compression shall be covered for both standard and custom
fit items
and supplies. Calibrated gradient sequential compression pumps with the
accompanying compression appliance consisting of eight or
more chambers,
for all affected areas of the body for purchase, shall be
covered when ordered by the
treating physician.
Podiatric
Intervention and Footcare shall
be covered monthly for toenail and wound prevention to include home
podiatric
care..
Wound
Management shall
include a requirement of a consultation or evaluation with a Certified
Compression therapist, and the implementation of a disease management
program. Patients experiencing wounds
due to lymphatic and vascular
disease, not including arterial disease, shall be placed on a home
management
program by a Certified Compression Therapist when wounds reoccur more
than
three times in one year, or wounds have been present for three months
or longer.
Health
Insurer’s Shall:
Page 3 of 8
Prohibited
Actions of and
Requirements of Insurers
Page 4 of 8
===========================
Join us as we work for lymphedema patients everywehere:
Advocates for Lymphedema
Dedicated to be an advocacy group for lymphedema patients. Working towards education, legal reform, changing insurance practices, promoting research, reaching for a cure.
http://health.groups.yahoo.com/group/AdvocatesforLymphedema/
Subscribe: | AdvocatesforLymphedema-subscribe@yahoogroups.com |
Pat O'Connor
Lymphedema People / Advocates for Lymphedema
===========================
For information about Lymphedema
http://www.lymphedemapeople.com/wiki/doku.php?id=lymphedema\
For Information about Lymphedema Complications
http://www.lymphedemapeople.com/wiki/doku.php?id=complications_of_lymphedema
For Lymphedema Personal Stories
http://www.lymphedemapeople.com/phpBB2/viewforum.php?f=3
For information about How to Treat a Lymphedema Wound
http://www.lymphedemapeople.com/wiki/doku.php?id=how_to_treat_a_lymphedema_wound
For information about Lymphedema Treatment
http://www.lymphedemapeople.com/wiki/doku.php?id=treatment
For information about Exercises for Lymphedema
http://www.lymphedemapeople.com/wiki/doku.php?id=exercises_for_lymphedema
For information on Infections Associated with Lymphedema
http://www.lymphedemapeople.com/wiki/doku.php?id=infections_associated_with_lymphedema
For information on Lymphedema in Children
http://www.lymphedemapeople.com/wiki/doku.php?id=lymphedema_in_children
Lymphedema Glossary
http://www.lymphedemapeople.com/wiki/doku.php?id=glossary:listing
===========================
Lymphedema People - Support Groups
-----------------------------------------------
Children
with Lymphedema
The time has come for families, parents, caregivers to have a support
group of
their own. Support group for parents, families and caregivers of
chilren with
lymphedema. Sharing information on coping, diagnosis, treatment and
prognosis.
Sponsored by Lymphedema People.
http://health.groups.yahoo.com/group/childrenwithlymphedema/
Subscribe: childrenwithlymphedema-subscribe@yahoogroups.com
......................
Lipedema
Lipodema Lipoedema
No matter how you spell it, this is another very little understood and
totally
frustrating conditions out there. This will be a support group for
those
suffering with lipedema/lipodema. A place for information, sharing
experiences,
exploring treatment options and coping.
Come join, be a part of the family!
http://health.groups.yahoo.com/group/lipedema_lipodema_lipoedema/?yguid=209645515
Subscribe: lipedema_lipodema_lipoedema-subscribe@yahoogroups.com
......................
MEN WITH LYMPHEDEMA
If you are a
man with lymphedema; a man with a loved one with lymphedema who you are
trying
to help and understand come join us and discover what it is to be the
master
instead of the sufferer of lymphedema.
http://health.groups.yahoo.com/group/menwithlymphedema/
Subscribe: menwithlymphedema-subscribe@yahoogroups.com
......................
All
About Lymphangiectasia
Support group for parents, patients, children who suffer from all forms
of
lymphangiectasia. This condition is caused by dilation of the
lymphatics. It can
affect the intestinal tract, lungs and other critical body areas.
http://health.groups.yahoo.com/group/allaboutlymphangiectasia/
Subscribe: allaboutlymphangiectasia-subscribe@yahoogroups.com
......................
Lymphatic
Disorders Support Group @ Yahoo Groups
While we have a number
of support groups for lymphedema... there is nothing out there for
other
lymphatic disorders. Because we have one of the most comprehensive
information
sites on all lymphatic disorders, I thought perhaps, it is time that
one be
offered.
DISCRIPTION
Information and support for rare and unusual disorders affecting the
lymph
system. Includes lymphangiomas, lymphatic malformations,
telangiectasia,
hennekam's syndrome, distichiasis, Figueroa
syndrome, ptosis syndrome, plus many more. Extensive database of
information
available through sister site Lymphedema People.
http://health.groups.yahoo.com/group/lymphaticdisorders/
Subscribe: lymphaticdisorders-subscribe@yahoogroups.com
......................
===========================
Lymphedema People New Wiki Pages
Have
you seen our new “Wiki”
pages yet? Listed
below are just a
sample of the more than 140 pages now listed in our Wiki section. We
are also
working on hundred more. Come
and
take a stroll!
Lymphedema
Glossary
http://www.lymphedemapeople.com/wiki/doku.php?id=glossary:listing
Lymphedema
http://www.lymphedemapeople.com/wiki/doku.php?id=lymphedema
Arm
Lymphedema
http://www.lymphedemapeople.com/wiki/doku.php?id=arm_lymphedema
Leg
Lymphedema
http://www.lymphedemapeople.com/wiki/doku.php?id=leg_lymphedema
Acute
Lymphedema
http://www.lymphedemapeople.com/wiki/doku.php?id=acute_lymphedema
The
Lymphedema Diet
http://www.lymphedemapeople.com/wiki/doku.php?id=the_lymphedema_diet
Exercises
for Lymphedema
http://www.lymphedemapeople.com/wiki/doku.php?id=exercises_for_lymphedema
Diuretics
are not for Lymphedema
http://www.lymphedemapeople.com/wiki/doku.php?id=diuretics_are_not_for_lymphedema
Lymphedema
People Online Support
Groups
http://www.lymphedemapeople.com/wiki/doku.php?id=lymphedema_people_online_support_groups
Lipedema
http://www.lymphedemapeople.com/wiki/doku.php?id=lipedema
Treatment
http://www.lymphedemapeople.com/wiki/doku.php?id=treatment
Lymphedema
and Pain Management
http://www.lymphedemapeople.com/wiki/doku.php?id=lymphedema_and_pain_management
Manual
Lymphatic Drainage (MLD) and Complex Decongestive Therapy (CDT)
Infections
Associated with Lymphedema
http://www.lymphedemapeople.com/wiki/doku.php?id=infections_associated_with_lymphedema
How
to Treat a Lymphedema Wound
http://www.lymphedemapeople.com/wiki/doku.php?id=how_to_treat_a_lymphedema_wound
Fungal
Infections Associated with
Lymphedema
http://www.lymphedemapeople.com/wiki/doku.php?id=fungal_infections_associated_with_lymphedema
Lymphedema
in Children
http://www.lymphedemapeople.com/wiki/doku.php?id=lymphedema_in_children
Lymphoscintigraphy
http://www.lymphedemapeople.com/wiki/doku.php?id=lymphoscintigraphy
Magnetic
Resonance Imaging
http://www.lymphedemapeople.com/wiki/doku.php?id=magnetic_resonance_imaging
Extraperitoneal
para-aortic lymph node dissection (EPLND)
Axillary
node biopsy
http://www.lymphedemapeople.com/wiki/doku.php?id=axillary_node_biopsy
Sentinel
Node Biopsy
http://www.lymphedemapeople.com/wiki/doku.php?id=sentinel_node_biopsy
Small
Needle Biopsy - Fine Needle Aspiration
http://www.lymphedemapeople.com/wiki/doku.php?id=small_needle_biopsy
Magnetic
Resonance Imaging
http://www.lymphedemapeople.com/wiki/doku.php?id=magnetic_resonance_imaging
Lymphedema
Gene FOXC2
http://www.lymphedemapeople.com/wiki/doku.php?id=lymphedema_gene_foxc2
Lymphedema Gene VEGFC
http://www.lymphedemapeople.com/wiki/doku.php?id=lymphedema_gene_vegfc
Lymphedema Gene SOX18
http://www.lymphedemapeople.com/wiki/doku.php?id=lymphedema_gene_sox18
Lymphedema
and Pregnancy
http://www.lymphedemapeople.com/wiki/doku.php?id=lymphedema_and_pregnancy
Home page: Lymphedema People
http://www.lymphedemapeople.com
Page Updated: Dec. 18, 2011