Congratulations to the State of Maryland for passage of the Health Insurance – Coverage for Lymphedema Diagnosis, Evaluation, and Treatment bill. In addition to coverage of compression items used in the treatment of lymphedema, this bill provides coverage for diagnosis, evaluation and treatment of lymphedema — coverage neglected by the Medicare Lymphedema Treatment Act (LTA).

In order to credit the appropriate activists involved in the Maryland lymphedema mandate, I offer the following facts:

1. Under the Affordable Care Act (ACA), Maryland coverage, is defined by the Maryland Essential Health Benefits in the selected Benchmark plan, and includes rehabilitation and habilitation services, and durable medical equipment.
2. Maryland carriers varied greatly as to their application of this largely undefined coverage to lymphedema treatment.
3. House Bill 113 Health Insurance – Coverage for Lymphedema Diagnosis, Evaluation, and Treatment introduced by Delegate Alfred Carr and 12 co-sponsors, was introduced on January 20, 2016 and re-introduced on February 1, 2017.
4. Both bills were withdrawn due to unfavorable report by the Health and Government Operations, probably because Maryland insurers claimed to already cover lymphedema treatment.
5. In December 2016 a report by NovaRest, Inc. commissioned by the Maryland Health Care Commission, disclosed that although lymphedema coverage was provided when medically necessary, there were coverage limitations on visits and compression supplies, and the Commission received patient’s complaints relating to inability to receive coverage for compression garments. Furthermore, a lymphedema mandate would not have substantial cost impact on healthcare costs in Maryland.
6. In March 2017 the Maryland Insurance Commission was requested to establish an informal workgroup of stakeholders to determine gaps in coverage and to report their findings to the Health and Government Operations Committee by December 1, 2017.
7. The Workgroup, headed by Bob Morrow, Associate Commissioner, Life & Health, Maryland Insurance Administration, comprised three Maryland Insurance Administration (MIA) employees (Courtney Hegadorn, Valerie Roebuck, and Erica Bailey), a lymphedema patient advocate (Robert Weiss), a lymphedema therapist (Maureen McBeth), and a carrier representative (Deborah Rivkin).
8. The Workgroup had two public meetings in September 2017 to gather inputs from Maryland stakeholders, including lymphedema patients, therapists, DMEPOS vendors, lymphedema activists, and insurance representatives.
9. The Workgroup also devised a questionnaire for all Maryland insurers to determine in detail the extent, limitations and gaps of their lymphedema insurance coverage.
10. Results from the NovaRest report, insurers’ surveys, and stakeholders meetings were collected and reported to the Maryland General Assembly on January 10, 2018, and resulted in reintroduction and passage of HB 847, signed into law May 8, 2018.
11. Stakeholder support was provided by Sarah Meyer and FLUID – Maryland (Fighting Lymphedema Unwise Insurance Denials) with marches, testimonies, letter-writing, and encouragement of insurance denial complaints.
12. The new law takes effect January 1, 2019. (maryland-2018-HB847-Chaptered.pdf)

Back to top
Lymphedema Treatment is Good Business as well as Good Medicine
© 2002 Robert Weiss, Porter Ranch, CA