Parent Education Classes

St. Luke’s * Idaho Elks Pediatric Services will be providing educational courses for the parents and care providers of our patients as well as children in the community.  The next parent training is scheduled for Thursday, February 5th, 2008.  Time is from 7-8:30pm and will be held in the Pauite Room, located in the lower level conference rooms of St. Luke’s Meridian.  Registration deadline is Friday, January 30th, 12pm.  Childcare is provided and snacks provided for all. 
 
Topic for February 5th is “Toileting Difficulties in Children” and will be presented by Wendy Rouse, DPT and Stephanie Whipps from the Idaho Center for Autism.  Wendy will present on Physical Therapy for Pediatric Voiding Dysfunction.  Presentation will include information on normal voiding patterns, types of voiding dysrunctions including: bedwetting, contributing factors to voiding dysfunctions, and what the physical therapist, doctor, and parent can do for the child.  Stephanie will present on toilint from a more behavioral/sensory approach. 
 
To sign up, please call Jasmynn at 489-5880.

Signs & Symptoms of Swallowing Problems

If you observe any of the following, a swallowing evaluation by a
speech-language pathologist may be necessary:

• Coughing or choking periods during or after eating or drinking

• Difficulty chewing and/or swallowing certain food textures
(e.g., hard, chewy or doughy foods)

• Foods or medication sticking in the throat

• Wet/gurgling vocal quality during or after eating or drinking

• Drooling

• Pocketing food inside cheeks

• Reflux after meals

• Excessive amount of time to eat a meal

• Recent unexplained weight loss

For more information, Call:
Nampa North Site ~ 1709 Caldwell Blvd., Nampa, ID 83651. Phone: (208) 489-4480
Talus Site ~ 3875 W. Overland Rd., Meridian, ID 83642. Phone: (208) 489-5060

Lymphedema: Medicare Coverage and the Lack There Of

Medicare covers the treatment of Lymphedema under Physical Therapy Services, but the compression bandages, garments and devices required are not covered.  Here is a portion of an article written by Robert “Bob” Weiss, M.S. NLN LE Legislative Advocate, which can be found on the National Lymphedema Network website,   http://www.lymphnet.org/

Medicare Coverage of Compression Garments:    Current Medicare policy does not cover the cost of the compression bandages, garments and devices required in the daily Phase 2 treatment of lymphedema. In mid-2000 Robert Weiss and the NLN made formal requests for a National Coverage Determination (NCD) on the treatment of lymphedema. Responses from the HCFA (now CMS) Coverage and Analysis Group centered around the claim that “the supplies, namely the compression garments used for the treatment of lymphedema, do not fall within a separate benefit category set forth in the Social Security Act.” (Dr. Sean Tunis, Director, in a letter dated March 1, 2001 ).

This unsubstantiated statement from HCFA/CMS, the basis for continuing denials of compression bandages and garments, has been disputed by Medicare Administrative Law Judges (ALJs) around the country. Most recently, four different California ALJs ruled in four different cases that compression bandages, sleeves and stockings used in the treatment of lymphedema meet the statutory definition of “prosthetic devices” in §1861(s)(8) of the SSA as expanded by CMS Pub. 100-2, Medicare Benefit Policy Manual , Ch. 15, §120 Prosthetic Devices.

On January 2, 2007 a request was made to CMS to add over 100 new and revised codes to the HCPCS Code Book for lymphedema treatment supplies. The CMS HCPCS Workgroup rejected this proposal on November 2, 2007 without referring to legal and medical arguments presented, only stating that “no insurer (i.e. Medicare, Medicaid, Private Insurance Sector) identified a national program operating need to establish unique codes to distinguish all the products listed in this application. Existing codes adequately describe the array of products available.    

In a recent discussion with SADMERC, the Medicare contractor responsible for developing and maintaining HCPCS codes, I was asked whether I was working with the manufacturers, since I have no standing to submit specific requests for product coding. In August 2006, while preparing the formal request for HCPCS code changes, I contacted major manufacturers of compression bandages and garments (i.e. Bellisse, BSN Jobst, CircAid, Derma Sciences, Hartmann-CONCO, Innovative Medical, Juzo, KT Medical, Lohmann Raucher, Medi, Lohmann, Peninsula Medical, Sigvaris-Ganzoni, Solaris, Telesto) asking them to submit requests to list their products as prosthetic devices with an L-code to demonstrate that there is a need for change. To my knowledge, no formal requests were submitted.

Robert “Bob” Weiss, M.S.
NLN LE Legislative Advocate

Check out more Legislative Updates at    http://www.lymphnet.org/lymphedemaFAQs/legislation/legUpdates/legUpdates.htm

 

 

Sonja M. Maul PT, CLT-LANA

National Board Certified Lymphedema Therapist

St. Luke’s*Idaho Elks Rehabilitation Services (SLIERS)