AAHomecare Challenges Aetna On New CPAP Adherence Guidance

WASHINGTON, D.C. – AAHomecare has asked Aetna to rescind new guidance requiring documentation of adherence codes for Medicare Advantage and commercial CPAP patients that is set to take effect on April 1. In a March 14 letter to Aetna, the Association points out the specified adherence codes (G8851, G8854, and G8855) can only be billed by certain clinicians and cannot be billed by DME suppliers.

AAHomecare also notes that requiring an adherence code during the initial 90 days of use should not be required as compliance is still being determined and that the new guidance does not conform to provisions in the 2024 Medicare Advantage and Part D Final rule clarifying that MA plans cannot deny coverage based on criteria not found in traditional Medicare.

AAHomecare officials are working with industry stakeholders and still seeking additional clarification on these new requirements that are outside the industry norm. See AAHomecare’s letter to Aetna here.

Congress Extends Telehealth Flexibilities Through September 2025

WASHINGTON, D.C. – The House and Senate passed a continuing resolution (CR) to maintain government funding at FY 2024 levels through Sept. 30, 2025. The CR includes provisions to extend Medicare telehealth flexibilities first established during the COVID-19 Public Health Emergency through Sept. 30, as well.

Shortly before the final vote, AAHomecare joined more than 90 healthcare organizations on a letter asking Congressional leadership to extend those provisions in the CR. AAHomecare has consistently advocated for extending telehealth flexibilities, most recently in its Sept. 6, 2024 comments on the CY2025 Physician Fee Schedule Proposed Rule.

Advocates will continue to work with other healthcare stakeholders to make sure the individuals utilizing DME can benefit from technologies like telehealth that streamline authorizations and allow for more connected and efficient care.