text: SECTION 1. SHORT TITLE.
  
      This Act may be cited as the ``Lymphedema Diagnosis and Treatment 
  Cost-Saving Act of 2011''.
  
  SEC. 2. COVERAGE OF LYMPHEDEMA DIAGNOSIS AND TREATMENT SERVICES UNDER 
                MEDICARE.
  
      (a) Coverage of Services.--Section 1861 of the Social Security Act 
  (42 U.S.C. 1395x) is amended--
              (1) in subsection (s)(2)--
                      (A) in subparagraph (EE), by striking ``and'' at 
                  the end;
                      (B) in subparagraph (FF), by adding ``and'' at the 
                  end; and
                      (C) by adding at the end the following new 
                  subparagraph:
                      ``(GG)(i) lymphedema diagnosis services (as defined 
                  in subsection (iii)(1)) and lymphedema treatment 
                  services (as described in subsection (iii)(2)); and
                      ``(ii) lymphedema compression treatment items (as 
                  defined in subsection (jjj)).''; and
              (2) by adding at the end the following new subsections:
      ``(iii) Lymphedema Diagnosis and Treatment Services.--(1) 
  Lymphedema Diagnosis Services.--The term `lymphedema diagnosis 
  services' means, with respect to an individual, the differential 
  diagnosis of the source of the individual's edema and the 
  identification of the specific etiology and functional lymphatic 
  deficiency, in which such diagnosis--
              ``(A) is provided by a provider, as defined in paragraph 
          (3), for the purpose of developing a lymphedema treatment plan; 
          and
              ``(B) may utilize any diagnostic tools the provider 
          determines to be reasonable and necessary.
      ``(2) Lymphedema Treatment Services.--The term `lymphedema 
  treatment services' means, with respect to an individual, services for 
  the treatment of lymphedema (regardless of cause)--
              ``(A) that are--
                      ``(i) provided in an inpatient or outpatient 
                  setting;
                      ``(ii) provided by a provider, as defined in 
                  paragraph (3), within the established scope of practice 
                  of such provider; and
                      ``(iii) medically necessary, in accordance with the 
                  current standard of lymphedema treatment, including 
                  complete decongestive therapy, which is a multi-modal 
                  therapy comprising of manual lymph drainage, 
                  compression therapy utilizing multilayer bandage 
                  systems, compression garments and devices, exercise, 
                  skin care, patient education, and any other lymphedema 
                  treatment modalities determined by the Secretary to be 
                  safe and effective; and
              ``(B) which shall--
                      ``(i) include as medically necessary with respect 
                  to the individual--
                              ``(I) an initial evaluation and course of 
                          clinical treatment, including initial baseline 
                          measurements and subsequent measurements to 
                          assess treatment efficacy and progress;
                              ``(II) follow-up courses of clinical 
                          treatment;
                              ``(III) in the case that such individual 
                          has cancer, clinical measurements, including 
                          initial pre-operative baseline measurements and 
                          periodic subsequent measurements to diagnose 
                          the presence of lymphedema; and
                              ``(IV) any other treatment modality 
                          approved by the Secretary; and
                      ``(ii) be provided in accordance with such 
                  schedule, duration, and number of treatments as 
                  determined medically necessary.
      ``(3) Provider Defined.--For purposes of this subsection and 
  subsection (jjj), the term `provider' means any licensed medical or 
  health care provider whose State licensing board recognizes lymphedema 
  diagnosis, lymphedema treatment, or both to fall within the scope of 
  practice of such medical or health care provider.
      ``(jjj) Lymphedema Compression Treatment Items.--The term 
  `lymphedema compression treatment items' means, with respect to an 
  individual, compression garments, devices, bandaging systems, 
  components, and supplies that are primarily and customarily used in the 
  medical treatment of lymphedema of the arms, hands, legs, feet, torso, 
  face and neck, breast and chest, abdomen, and genitalia, as prescribed 
  by a provider, as defined in subsection (iii)(3). Such term includes--
              ``(1) multilayer compression bandaging systems, including 
          short-stretch and medium-stretch compression bandages; cotton, 
          synthetic, or foam padding; gauze or elastic finger and toe 
          bandages; foam pads; directional flow padding; and tubular 
          bandages;
              ``(2) custom or standard fit gradient compression garments;
              ``(3) non-elastic and low-elastic compression garments, 
          manually adjustable or fitted padded directional flow garments 
          (with or without elastic or non-elastic compression jackets) 
          and compression wraps and directional flow pads;
              ``(4) aids and ancillary equipment consisting of donning 
          aids, bandage rollers, shoes to fit over compression items, and 
          other specialized items used with the items described in 
          paragraphs (1) through (3);
              ``(5) pneumatic appliances connected to and used in 
          conjunction with pneumatic sequential compression controllers;
              ``(6) any other compression garments, bandaging systems, 
          devices, and aids determined by the Secretary to be effective 
          in the prevention or treatment of lymphedema; and
              ``(7) replacements of any items under this subsection in 
          accordance with section 1834(p)(3).''.
      (b) Payment.--
              (1) Lymphedema compression treatment items.--
                      (A) In general.--Section 1833(a) of such Act (42 
                  U.S.C. 1395l(a)) is amended--
                              (i) in paragraph (8), by striking at the 
                          end ``and'';
                              (ii) in paragraph (9), by striking at the 
                          end the period and inserting a semi-colon; and
                              (iii) by adding at the end the following 
                          new paragraph:
              ``(10) in the case of lymphedema compression treatment 
          items described in section 1861(jjj), the amount determined 
          under section 1834(p); and''.
                      (B) Payment determined.--Section 1834 of such Act 
                  (42 U.S.C. 1395m) is amended by adding at the end the 
                  following new subsection:
      ``(p) Payment for Lymphedema Compression Treatment Items.--
              ``(1) General rule for payment.--
                      ``(A) In general.--With respect to a lymphedema 
                  compression treatment item as defined in section 
                  1861(jjj)) for which payment is determined under this 
                  subsection, subject to subparagraph (D), payment shall 
                  be made in an amount equal to 80 percent of the payment 
                  basis described in subparagraph (B).
                      ``(B) Payment basis.--The payment basis described 
                  in this subparagraph, with respect to a lymphedema 
                  compression treatment item described in section 
                  1861(jjj), is the actual charge for the item.
                      ``(C) Exclusive payment rule for home health 
                  agencies.--Notwithstanding any other provision of this 
                  title, this subsection shall constitute the exclusive 
                  provision of this title for payment for lymphedema 
                  compression treatment items described in section 
                  1861(jjj) under this part or under part A to a home 
                  health agency or for such items that are furnished as 
                  an incident to a physician's professional service.
              ``(2) Allowable quantities.--In the case it is determined 
          by a provider, as defined in section 1861(iii)(3), that 
          lymphedema compression treatment items are required as part of 
          lymphedema treatment services under section 1861(iii)(2), then 
          payment may be made under this title in accordance with this 
          subsection for such items in the quantity which is customary, 
          reasonable, and medically necessary.
              ``(3) Replacement of lymphedema compression treatment 
          items.--
                      ``(A) In general.--Payment shall be made under this 
                  subsection, with respect to an individual, for the 
                  replacement of a lymphedema compression treatment item 
                  if the period of the reasonable and useful lifetime of 
                  the item (as described in subparagraph (B)) has expired 
                  or a provider, as defined in section 1861(iii)(3), 
                  determines that a replacement, or repair, of such item, 
                  is medically necessary.
                      ``(B) Reasonable and useful lifetime.--For purposes 
                  of subparagraph (A), the period of the reasonable and 
                  useful lifetime of a lymphedema compression treatment 
                  item is as follows:
                              ``(i) In the case of any item described in 
                          section 1861(jjj)(1), 1 year.
                              ``(ii) In the case of any item described in 
                          section 1861(jjj)(2), 6 months.
                              ``(iii) In the case of any item described 
                          in section 1861(jjj)(3), 2 years.
                              ``(iv) In the case of any item described in 
                          section 1861(jjj)(4), 1 year.
                              ``(v) In the case of any item described in 
                          section 1861(jjj)(5), 5 years.
                              ``(vi) In the case of any item described in 
                          section 1861(jjj)(6), such period as determined 
                          by the Secretary, in consultation with 
                          appropriate health organizations, at the time 
                          the Secretary determines such item to be 
                          effective in the prevention or treatment of 
                          lymphedema.''.
                      (C) Application of supplier requirements.--Section 
                  1834(j)(5) of such Act (42 U.S.C. 1395m(j)(5)) is 
                  amended--
                              (i) in subparagraph (E), by striking at the 
                          end ``and'';
                              (ii) in subparagraph (F), by striking at 
                          the end the period and inserting ``; and''; and
                              (iii) by adding at the end the following 
                          new subparagraph:
                      ``(G) lymphedema compression treatment items (as 
                  defined in section 1861(jjj)).''.
              (2) Lymphedema diagnosis and treatment services.--
                      (A) In general.--Section 1833(a) of such Act, as 
                  amended by paragraph (1)(A), is further amended by 
                  adding at the end the following new paragraph:
              ``(11)(A) in the case of lymphedema diagnosis services (as 
          defined in section 1861(iii)(1)) furnished by a provider (as 
          defined in section 1861(iii)(3)) the amount described in 
          section 1834(q); and
              ``(B) in the case of lymphedema treatment services (as 
          defined in section 1861(iii)(2)) furnished by a provider (as 
          defined in section 1861(iii)(3)) the amount described in 
          section 1834(k).''.
                      (B) Payment method.--Section 1834 of such Act, as 
                  amended by paragraph (1)(B), is further amended by 
                  adding at the end the following new subsection:
      ``(q) Payment for Outpatient Lymphedema Diagnosis and Treatment 
  Services by Physicians and Non-Physician Practitioners.--
              ``(1) In general.--For purposes of section 1833(a)(11), the 
          amount described in this subsection, with respect to a 
          lymphedema diagnosis service or lymphedema treatment service, 
          is 80 percent of the lesser of--
                      ``(A) the actual charge for the service; or
                      ``(B) the applicable fee schedule amount (as 
                  defined in paragraph (2)) for the service.
              ``(2) Applicable fee schedule amount.--In this subsection, 
          the term `applicable fee schedule amount' means, with respect 
          to services furnished in a year, the amount determined under 
          the fee schedule established under section 1848 for such 
          services furnished during the year.''.
                      (C) Conforming amendment for payments under 
                  1834(k).--Section 1834(k)(1) of such Act (42 U.S.C. 
                  1395m(k)(1)) is amended by striking ``or 1833(a)(9)'' 
                  and inserting ``1833(a)(9), or 1833(a)(11)''.
      (c) Effective Date.--The amendments made by this section shall 
  apply to items and services furnished on or after the date that is 180 
  days from the date of the enactment of this Act.
target: Lymphedema Diagnosis and Treatment Cost Savings Act of 2011 - Amends title XVIII (Medicare) of the Social Security Act to extend coverage to lymphedema diagnosis and treatment services. including lymphedema compression treatment items.
feat_title: To amend title XVIII of the Social Security Act to improve the diagnosis and treatment of lymphedema under the Medicare program and to reduce costs under such program related to the treatment of lymphedema.