Senate Bill 3963

Written by Amber Vachon

*NOTE: This bill never became law. This bill was proposed in a previous session of Congress. Sessions of Congress last two years, and at the end of each session all proposed bills and resolutions that haven’t passed are cleared from the books.

There is a bill currently in the US Senate that will, when passed, allow for much greater access to lymphedema treatment for Medicare recipients. This is vital, especially for breast cancer survivors who have a significantly higher likelihood of developing lymphedema than the general population.

Currently, only physical therapists may provide this therapy. The new law will restore physician choice to assign care to the therapist of his or her choice. A large percentage of lymphedema therapists with advanced training (myself included) are massage therapists and nurses (LPNs and RNs). As a result, the number of qualified therapists who can provide this service under Medicare is greatly limited. With passage of this bill, patient access to quality healthcare will be greatly enhanced. Private insurance companies also tend to follow Medicare’s lead, thus better access to physical medicine for those not on Medicare should follow.

In order to ensure proper care for those who need it, we need your support. Please contact your Congressmen and women and urge them to co-sponsor this bill and vote yes to S.3963. (History has shown that the more co-sponsors a bill has, the greater the likelihood of it’s passage.)

There is an easy way for those with internet access to find contact information for those in Congress. Go to Then enter your zip code and click the “Submit It” button. You will then be shown the names of your Senators and Representative, plus a direct link to their email addresses, as well as their telephone and fax numbers. Most of them have web forms that can be filled out and submitted quickly.

You may then write your own message to your Congressperson — or, if you prefer, you may copy and paste the text from the sample letter below. If you wish to use the text below (as is or modified), it may be easier to copy it before you go to the link above.

A sample letter to your representative:

Dear Congressperson,

I am writing to urge you to co-sponsor and vote yes to Senate bill 3963, the passage of which will accomplish three important things:

  • It will improve Medicare beneficiaries’ access to quality healthcare by amending a recent Medicare ruling.
  • It will restore the rights of physicians to choose how and to whom they delegate the delivery of therapy services.
  • It will save Medicare money by allowing health professionals who are state-authorized or certified to deliver physical medicine or rehabilitation services and to provide these services incident to physicians’ services.

This bill is supported by The Coalition to Preserve Patient Access to Physical Medicine and Rehabilitation, which is comprised of 23 healthcare organizations representing a wide range of health professionals, medical specialties and patients cared for under those specialties. The Coalition’s goal is to reverse the therapy-incident to rule, which needlessly restricts Medicare beneficiaries’ access to quality therapy and the ability of physicians to deliver care to the best of their abilities.

A recent Medicare ruling which greatly decreased access to treatment for breast cancer patients and other patients with lymphedema. The ruling changed who can be reimbursed for performing Combined Decongestive Therapy, the gold standard in treatment of lymphedema. The ruling limits treatment delivery to Occupational Therapists (OTs) and Physical Therapists (PTs).

Interestingly, OTs and PTs are not adequately trained to perform these services without further specialized training. Currently, about one-half of all therapists trained to perform CDT are either Massage Therapists or Nurses (RN or LPN). These therapists are providing a medically necessary service for which they have received specialized training and certification by national lymphedema therapy organizations.

My understanding is that this ruling was made after pressure was put on Medicare by representatives of OT and PT organizations who were concerned about Athletic trainers taking their market share in other treatment areas. This ruling is counter to the certification standards set by The Lymphology Association of North America, which has set proper training for lymphedema therapists through the LANA certification process. I can support their training methodology as medically adequate for providing needed lymphedema services.

If we do nothing, then breast cancer patients across the country will suffer, as will other patients with lymphedema of the upper or lower extremities. Furthermore, PTs and OTs will be able to bill for lymphedema services, although they in some cases do not have the advanced training necessary to provide adequate care. I urge you to help reverse this ruling and support LANA certification, which has broad support from prominent physicians specializing in lymphedema treatment and would be available to PTs and OTs, as well as RNs, PTAs, MTs, MDs, and DOs.

If the new rule remains in effect, it not only eliminates the choice of qualified therapy providers, but also reduces the quality of care and access to health care for the patient. In short, it will contribute to the growing shortage of therapy providers in the U.S. today.

As lymphedema treatment is just becoming mainstream in the US now, we are at a critical juncture to help insure proper training and treatment of patients. I am asking for your help to reverse the Medicare ruling and to support LANA certification as the standard for lymphedema care. At the same time, we need a time-frame of 5 years to make this certification the standard-of-care, so as to allow a grandfather period to allow those not certified to do so, and ensure continuity of care for patients, and a pathway for proper certification.

Thank you for your time and attention.

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