January 20, 1999

Ms. Barbara Riley, RN
Medical Review
Blue Cross of Washington and Alaska
P.O. Box 2847
Seattle, WA 98111-2847

Dear Ms. Riley:

The American Association for Respiratory Care has received your December 16, 1998 response to our comments on the Alaska Local Medical Regional Policy.

In your letter you state:

"We consider the Declaration from Jann Robinson, CRRN, of the HCFA Regional Office, to be relevant, and as with all HCFA directives, it is to be followed."

1. It is our understanding that the Declaration from Ms. Robinson (Attachment No. 1) was admitted as part of a 1997 claims denial appeals case for one nursing home in the Pacific Northwest.

2. We were unaware that this opinion statement was elevated to a HCFA directive. We have requested that the HCFA Regional Office provide specific details including when this significant coverage directive became effective and what steps were taken to provide a period of public comment as is required under the Administrative Procedures Act.

Additionally you state:

" Furthermore, with all due respect to your beliefs, we concur with the findings contained in the declaration by Jann Robinson."

With all due respect to you, please provide the AARC with the objective evidence used by your organization that has led you to accept the statements made within Ms. Robinson's Declaration.

The AARC continues to receive inquiries from consumers regarding the safety of respiratory therapy services and the competency of those providing respiratory therapy services in nursing homes.

The recently implemented Local Medical Regional Policy (LMRP) for Alaska, as well as your statement that Ms. Robinson's Declaration has been elevated to a HCFA Regional Office directive may negatively affect the safety of a significant number of Medicare beneficiaries when respiratory therapy services are rendered in nursing homes.

When we receive the objective evidence used by your organization to revise the coverage of respiratory therapy services in nursing homes, we will share this information with consumers. We believe it is critical to reassure the public that your coverage policies are based on objective evidence. Consumers need reassurance that their safety will not be jeopardized because of the implementation of revised respiratory therapy coverage policies.

We look forward to your prompt response.

Sincerely,

Sam P. Giordano, MBA, RRT
Executive Director

SG/bd

Attachment

cc: Horace Deets, American Association of Retired Persons
Martha Mohler, National Committee to Preserve Social Security and Medicare
Sarah Green Burger, National Citizens' Coalition for Nursing Home Reform
David Swankin, Citizen Advocacy Center
Blairlee M. Hawes, TREA Senior Citizens League

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