With help from the American Association of Breast Care Professionals (AABCP), two U.S. Senators have co-sponsored federal legislation to ensure Medicare reimbursement of custom breast prostheses. On April 22, Blanche Lincoln (D-AK) and Olympia Snowe (R-ME) put their names to S.3255, the Custom Fabricated Breast Prosthesis Act of 2010, whose original language was developed by an AABCP team.
The bill, also known as “A bill to amend title XVIII of the Social Security Act to provide coverage for custom fabricated breast prostheses following a mastectomy,” is designed to circumvent a down-coding process inherent in the Medicare reimbursement structure. “There is an existing L-Code allowable for custom breast forms-the L-Code is L-8035-but within the local coverage determinations, they down-code it to the ‘least costly alternative,’ which is a standard, off-the-shelf breast form,” said AABCP President Rhonda Turner, MBA, JD, PhD, CFM, BOCPO.
Without the new bill, Turner told The O&P EDGE, “The average person will never be able to afford a custom breast form-it’s in the Medicare budget, but it will never be paid because of the way the policy is written.” Considering the ten-fold reimbursement difference between the custom and off-the-shelf forms, Turner added, “No doctor or practitioner will go through the work of making a custom form if they know they won’t be reimbursed, and the custom is just expensive enough not to be affordable for most people.”
According to AABCP, the association is “proud to be the author and defender of such important piece of legislation.” Turner said, “A couple of people on our government-relations committee were working on this, and once Senator Lincoln-who has been extraordinarily helpful-got to a certain point, we asked whether if we wrote the bill it would go any faster, and she said yes. We put in what we felt was appropriate…and while the legislative aides and senators ultimately wrote the bill, this is something that from start to finish comes from AABCP. We’re very proud of that.”
Turner stated in a press release that AABCP “believes that this bill will raise awareness not only for the need for coverage for custom breast forms but adequate coverage for all necessary post-mastectomy treatments.” Turner also noted personally that in late 2009 AABCP performed congressional office visits, speaking “to a couple of dozen people on both sides of Hill, and everyone was very supportive of our concept [so] we hope that many of the them will agree to co-sponsorship.” She also noted that an identical bill already has a sponsor in the House of Representatives and is now seeking a cosponsor.
“We’re very excited about this,” Turner concluded. “We’ve been working on this for about a year and a half, and women need and deserve this option.”