AAHomecare and ALS Association Continue to Press CMS on MA NIV Coverage Issues
WASHINGTON, D.C. – Respiratory providers and patient advocates believe that coverage determinations for Non-Invasive Ventilation (NIV) devices by Medicare Advantage (MA) plans are being made incorrectly and are imposing more restrictive criteria than traditional Medicare allows.
Last week, AAHomecare and the ALS Association shared fresh perspectives with the agency about MA plans that are “ignoring physician’s orders and instead use excessive prior authorization requirements, requiring ‘fail first’ on Respiratory Assistance Devices (RAD) for patients that need an NIV device and, in some instances, outright denying NIV to ALS patients.”
The Oct. 4 letter to CMS drives home the fact that NIVs are designed and FDA-approved to treat chronic respiratory failure (CRF), while RADs are designed and approved to treat sleep apnea. The letter also cites peer-reviewed research showing that NIV use significantly reduces mortality and health care spending in Medicare patients with chronic respiratory failure.
AAHomecare remains committed to working with our patient group allies to strengthen prompt access to NIV for individuals with severe respiratory challenges and will look to engage Capitol Hill on the issue if CMS fails to address these concerns.
See the AAHomecare/ALS letter here.
CRT Repair Reform Initiatives Discussed at In-Person Strategy Session
WASHINGTON, D.C. – This week, NCART held a CRT Repair Reform strategy meeting in Washington, DC with representatives from across the CRT space and around the country. The volunteer leaders gathered to assess the repair reform initiatives from the last year and to plan out ways to improve the CRT repair process.
“The meeting was a good kick-off to what will be lots of activity focused on repairs over the next few months,” noted Alexis Ward, senior director of payer relations, who represented AAHomecare at the session. “AAHomecare is honored to be part of the Repair Reform efforts.” To learn more about CRT Repair Reform, contact Alexis Ward at [email protected].
Pressing Issues At Diabetes Council Meeting
WASHINGTON, D.C. – AAHomecare’s Diabetes Council met for their annual in-person meeting in Arlington, VA. The Council discussed a wide range of pressing issues for CGM suppliers. Ensuring state Medicaid programs maintain CGM coverage in the DME channel continues to be a top priority for the Council. In addition, the Council continues to discuss issues with cross-over claims, 90-day supply/30-day billing, and new code adoption. The Council will be convening again in January for a two-day virtual meeting.
