For several years, the AARC has joined forces with other medical societies in recommending the Centers for Medicare and Medicaid Services (CMS) update its policies on noninvasive home mechanical ventilation that date back to recommendations from a 1998 consensus conference report (CHEST 1999; 116-521-534). Current policies are cumbersome and overly restrictive and present barriers that have interfered with delivering the right type of equipment to Medicare beneficiaries based on their clinical need. A formal request to CMS asking them to reconsider the national policy to address the advances in technologies over the past two decades and to consider pertinent new clinical evidence went unanswered until recently.
Review of Scientific Evidence
On July 22, 2020, CMS convened the Medicare Evidence Development & Coverage Advisory Committee (MEDCAC) to determine their level of confidence of clinical evidence supporting the use of bi-level, CPAP, and noninvasive ventilators in individuals with respiratory failure consequent to Chronic Obstructive Pulmonary Disease (COPD). The MEDCAC was established to provide independent guidance and expert advice to CMS on specific clinical topics with CMS having the ultimate authority to make final decisions. Although not a voting member, a representative from AARC’s Board of Medical Advisors was invited to participate in the meeting. A transcript of the meeting and scoresheet are available here. Prior to the meeting, the Agency for Healthcare Quality and Research released its final technology assessment on “Noninvasive Positive Pressure Ventilation in the Home” which provided additional information in the MEDCAC’s deliberations.
Technical Expert Panel Convened
Together these actions resulted in the development of an informal Technical Expert Panel (TEP) led by the American College of Chest Physicians (CHEST) with representatives from the AARC, the American Thoracic Society (ATS), and the American Academy of Sleep Medicine (AASM) and supported by CMS. The goal of the TEP is to develop recommendations in the form of a National Coverage Determination (NCD) for CMS’ use in implementing final policies that resolve longstanding barriers to deliver optimal noninvasive ventilation to Medicare beneficiaries.
A two-day virtual conference was convened on October 3 and 4 with the panels headed by physicians from CHEST, ATS and ASSM. Two representatives from AARC were included on the panels to represent the importance of respiratory therapists’ clinical expertise in the overall management of individuals on noninvasive ventilation, especially those who suffer from neuromuscular diseases. The panels consisted of five diagnostic categories that are addressed in current coverage policies. These included 1) Bilevel Transition from CPAP- When Therapeutic Benefit Was Not Achieved, 2) Severe COPD, 3) Hypoventilation Syndrome, 4) Thoracic Restrictive Disorders, and 5) Complex/Central Sleep Apnea.
Representatives from patient advocacy groups, the home medical equipment industry and ventilator manufacturers were invited to give presentations and provided valuable information to inform the decision-making process. A writing committee comprised of the panel chairs and co-chairs will provide a final document to be presented for a peer-reviewed publication expected to be available in November 2020.
The AARC is pleased to be a part of this important endeavor that can lead to better patient outcomes for respiratory patients who need noninvasive ventilation to help them breathe.