WASHINGTON, DC – Last week, the House Energy and Commerce Committee approved H.R. 8158, legislation to address a payment disparity for stationary oxygen products stemming from the application of outdated budget neutrality provisions in the 1997 Balanced Budget Act.
As AAHomecare noted in the new legislation, these provisions are drawn from H.R. 2771, legislation that combines the budget neutrality fix with permanent relief for suppliers in rural and other non-bid areas. The House Energy and Commerce Committee had requested the new legislation be introduced for separate committee consideration since Congress had already provided relief to these areas through the duration of the PHE in COVID-19 legislation. While AAHomecare and other industry stakeholder groups have registered our support for H.R. 8158, we remain committed to securing long-term relief for suppliers in rural communities and other non-bid areas.
On a related note, H.R. 2771 has picked up four new co-sponsors since the end of the August recess: Reps. Troy Balderson (R-Ohio), Brian Fitzpatrick (R-Pa.), Bob Latta (R-Ohio), and Tom O’Halleran (D-Ariz) – see complete co-sponsor list here. We urge you to continue to ask your legislators to support H.R. 2771 and will alert the HME community if grassroots advocacy is needed on H.R. 8158.
Humana Changes NIV Authorization Process with No Formal Notification
WASHINGTON, DC – Humana communicated a change in the authorization process for non-invasive ventilators with providers. This surprise alteration, which lacked formal notification of material change, will include only providing a 90-day initial authorization and requiring compliance data to extend authorization.
AAHomecare is drafting a response to Humana which outlines our many concerns with this authorization change to this life sustaining equipment, including:
- impact to patients,
- potential re-hospitalizations,
- policy is out of line with Medicare requirements, and
- implementing a more restrictive authorization process during a public health emergency
We will keep our members apprised of our continued engagement with Humana regarding this issue.
CMS Accepting Home Oxygen NCD Comments Until Sept. 16
WASHINGTON, DC – On August 17, CMS announced the review for the National Coverage Determination (NCD) for home use of oxygen titled, “National Coverage Analysis (NCA) Tracking Sheet for Home Use of Oxygen and Home Oxygen Use to Treat Cluster Headaches (CAG-00296R2).” In addition to the review of oxygen for cluster headaches, due to the current COVID-19 Public Health Emergency (PHE), CMS is also taking this opportunity to review the NCD to ensure patient access is not compromised during and after this PHE.
AAHomecare will be offering broad recommendations to the NCD for home use of oxygen to improve patient access. Below are the key points from our comments:
- AAHomecare recommends CMS remove the CMN requirement as it is currently only utilized as a billing tool and is a burdensome requirement for oxygen suppliers and clinicians that must complete this document.
- Allow coverage for acute respiratory conditions and other non-respiratory illnesses that impact oxygen saturation levels.
- Minimize the requirement for patients to try other alternative treatments prior to being prescribed oxygen.
- Require the adoption of the Clinical Data Elements developed by CMS and the industry by health systems and prescribers, and utilize this information as the only documentation requirements for suppliers.
CMS is accepting comments until September 16. You can submit your comments here.
Comment Guidance on Telehealth/RPM for Physician Fee Schedule Proposed Rule
WASHINGTON, DC – CMS has published the Physician Fee Schedule Proposed Rule that includes proposals to expand coverage for some telehealth and remote physiologic monitoring (RPM) services. Although the proposals are specific to payments for physician services, AAHomecare is taking this opportunity to provide support for expanding coverage as it pertains to DMEPOS.
In the letter, AAHomecare will strongly recommend virtual services that have been covered during the PHE to be allowed on a permanent basis after the PHE. The industry has seen that virtual services provided during this PHE has promoted social distancing and has greatly improved the access to care without compromising the quality of services. AAHomecare will also recommend CMS allow RPM to satisfy the requirement for the face-to-face encounter and adopt policies that would improve the partnership between the DMEPOS industry and physician community in caring for patients.
CMS is accepting comments until October 5, 2020. Members interested in this comment opportunity are welcome to support AAHomecare’s positions by including the points made in our letter or by including a copy of AAHomecare’s forthcoming comments, which we will share once finalized.