May 20, 1999
The AARC has recently submitted formal comments to the Health Care Financing Administration regarding their recent transmittal on hyperbaric oxygen therapy (HBO).

Because the jobs of many respiratory therapists were threatened by this policy, the AARC made a strong statement to HCFA's director of Coverage and Analysis. Transmittal AB-99-21 would require that 1) physicians be in constant attendance at the bedside during HBO therapy, and that 2) they would have to undergo extensive credentialing requirements. These demands placed on HBO therapy were threatening the closure of many HBO units around the country, and with it the jobs of respiratory therapists.

In comments directed to HCFA, the AARC called for:

1. Evidence that points to a need to have a physician at the bedside constantly. "What is not critical, is medically unjustifiable, and is extremely costly to the Medicare program is the enforcement of the requirement that demands the physician's attendance during the entire hyperbaric oxygen therapy procedure regardless of the medical stability of the patient," said AARC President Dianne Kimball in her letter.
2. Clarification of the need for physicians to be certified in Advanced Cardiac Life Support.
3. Clarification on how physicians can meet the requirement for 60 hours of training in hyperbaric medicine, when the organizations that provide this training have core courses of only 40 hours.

HCFA has stated that the implementation of this policy has been delayed from May 1 to July 1, but no official confirmation has yet been forthcoming on this point.

June 11, 1999
Implementation of Health Care Financing Administration revisions to Medicare's coverage of hyperbaric oxygen therapy, set for May 1, 1999, has been delayed until July 1, 1999.

HCFA says the delay allows time for carriers and intermediaries to educate their providers and for HCFA to review comments received after the changes were released. Contractors should contact the appropriate regional office staff with any questions. Regional office staff may direct questions to Joan Proctor-Young (carrier operations) at 410/786-0949 and Barbara Strickland (intermediary operations) at 410/786-0506. Contact Dorothy HOnemann at 410/786-5702 with questions relating to CR 796.

July 7, 1999
Thanks to efforts by the AARC and other associations and professional organizations, the Health Care Financing Administration (HCFA) has delayed implementation of Change Request 796: Coverage Issues Manual 35-10, Hyperbaric Oxygen (HBO) Therapy.

The revised Coverage Issues Manual 35-10, coverage of HBO therapy, was scheduled to be in effect July 1, 1999. The new start date is the result of comments made by the AARC, Undersea and Hyperbaric Medical Society, and the American Medical Association regarding skin graft, physician attendance, credentialing requirements, and the ICD-9-CM diagnosis codes used to identify covered conditions.

HCFA says that final instructions will be distributed January 1, 2000, to allow time for carriers and intermediaries to educate their providers to incorporate any changes. Until final instructions are issued, paragraph 35-10 of the Coverage Issues Manual remains in effect in its original form. Any changes made to comply with CR 796, CR 895, and PM AB-99-32 or AB-99-21 must be removed.

For more information, visit the HCFA Web site at http://www.hcfa.gov or the Undersea and Hyperbaric Medical Society Web site at http://www.uhms.org. You may review the AARCís comments and information sent to HCFA at http://www.aarc.org/govt_affairs/hbo_letter.html.