On May 16, 2019, 19 patient and pulmonary groups signed a joint letter to the Secretary of Health and Human Services (HHS) and the Administrator of the Centers for Medicare and Medicaid Services (CMS) opposing CMS’ decision to include noninvasive ventilators in the FY 2021 round of competitive bidding. While that seems like a long time from now, the window to submit bids begins July 16 and ends Sep. 18, 2019. So, much work is needed as quickly as possible to get CMS to reverse their decision.
What we’re doing
The AARC, working with the National Association for Medical Direction of Respiratory Care (NAMDRC) and the ALS (Amyotrophic Lateral Sclerosis) Association, took the lead in developing the joint letter and scheduling meetings with key House and Senate leaders to voice our strong opposition. CMS covers ventilators for the treatment of neuromuscular diseases, thoracic restrictive disease and chronic respiratory failure due to COPD. Hill staff were educated on the devasting effects patients with these diseases faced if ventilators were furnished by the lowest bidder. Because ventilators are paid under CMS’ “frequent and substantial services” payment category, it would set a precedent if these devices were moved to competitive bidding where all other devices are currently classified as “capped rental.”
“Because ventilators require constant vigilance and adjustment as a patient’s need changes, we stressed in Hill briefings that it is imperative for a respiratory therapist to make regular home visits as part of the standard of care due to their expertise,” said Anne Marie Hummel, Associate Executive Directors for Advocacy and Government Affairs.
She also stressed the professional services of a respiratory therapist are not covered under the durable medical equipment benefit, highlighting “suppliers will no longer to be able to cover the cost of their clinical support as a result of lower reimbursement rates which will result in a deterioration of patient safety and care.”
For five years, the pulmonary community, including AARC, has repeatedly recommended a revision to CMS’ home mechanical ventilation policies to reflect the technological advancements made over the past two decades to these life-sustaining and life-supporting devices. Moving ventilators under competitive bidding will not fix the problem; policies need to be changed.
AARC, NAMDRC and others have developed legislation language requiring CMS to exclude ventilators permanently from competitive bidding and to convene a Technical Expert Panel to address the coverage issues. Additional Hill briefings are being scheduled to secure co-sponsorship of a bill. Several other advocacy efforts are under way spearheaded by the home medical equipment industry that include a “Dear Colleague” letter asking CMS to reconsider its position and Senate Appropriations report language directing CMS not to expand competitive bidding to include any type of ventilation equipment, suppliers or services.
What you can do
As an AARC member, we need your support in securing signatures on the “Dear Colleague” letter.
AAHomecare has set up an ACTION CENTER which we encourage you to use now.
We need to engage in every measure possible to prevent CMS from moving forward with this untenable decision; time is of the essence.