Requires health insurance coverage for lymphedema

Title of bill

An act to amend the insurance law, in relation to requiring certain health insurance coverage for lymphedema

Purpose

Requires health insurance providers to cover the differential diagnosis and treatment of lymphedema. Such coverage shall include, in addition to benefits for a course of manual lymph drainage whose frequency and duration is determined by the treating physician or therapist based on medical necessity and not based on physical therapy and rehabilitation standards, benefits for equipment, supplies, devices, complex decongestive therapy, and outpatient self-management training and education for the treatment of lymphedema if prescribed by a health care professional legally authorized to prescribe or provide such items under Title 8 of the education law. Lymphedema therapy administered under section 2 shall be administered only by a therapist certified to perform lymphedema treatment by the Lymphology Association of North America (LANA) or certified in accordance with standards equivalent to the certification standards of LANA. Such equipment, supplies or devices shall include, but not be limited to, bandages, compression garments, pads, orthotic shoes and devices.

Summary of provisions

1. Subsection (i) of section 3216 of the Insurance Law is amended by adding a new paragraphs 26 and 27; §2. Subsection (k) of section 3221 of the Insurance Law is amended by adding a new paragraph 14; §3. Section 4303 of the Insurance Law is amended by adding a new subsections (ff) and (gg).

Justification

This bill requires insurers to cover equipment, supplies, devices, complex decongestive therapy, and outpatient self-management training and education for the treatment of lymphedema which are not necessarily uniformly covered by them.

Lymphedema is an accumulation of lymphatic fluid in the interstitial tissue that causes swelling, most often in the arm(s) or leg(s), and occasionally in other parts of the body. Lymphedema can develop when lymphatic vessels are missing or impaired (primary), or when lymph vessels are damaged or lymph nodes removed (secondary).

Radiation therapy, used in the treatment of various cancers and some AIDS-related diseases can damage otherwise healthy lymph nodes and vessels, causing scar tissue to form which interrupts the normal flow of the lymphatic fluid.

Moreover, untreated, lymphedema can lead into a decrease or loss of functioning of the limbs, skin breakdown, and chronic infections. In the most severe cases, untreated lymphedema can develop into a rare form of lymphatic cancer.

Legislative history

2008 Insurance Committee (S.1544A/A.7077A). 2005-2006 Insurance Committee (S.3015/A.5003-A). 2004 Insurance Committee (S.7005/A.9208).

Fiscal implications

EFFECTIVE DATE : This act shall take effect on the first of January succeeding the date on which it shall have become law and shall apply to all insurance policies, contracts and plans issued, renewed, modified, altered or amended on or after such date.