CMS Reclassifies Some Respiratory Assist Devices

BALTIMORE–Certain respiratory assist devices, including some
continuous positive airway pressure devices, are being reclassified
as capped-rental items, CMS announced last week.

Effective April 1, RADs with bi-level capability and a backup
rate–what used to be known as “intermittent assist devices with
continuous positive airway pressure devices”–will no longer be
considered DME requiring “frequent and substantial servicing for
payment purposes,” the agency said in a statement on Thursday.

Instead, monthly rental payments from Medicare will decrease at
the fourth month of rental, and after 13 months of rental, title
will transfer to the beneficiary and payments will stop altogether.
Medicare will continue to pay 80 percent, and beneficiaries 20
percent, of the Medicare allowed payment amount for maintenance for
the equipment after the rental payments end.

But in a response issued late Friday, the American Association
for Homecare said it is “dismayed” at the rule and disagrees with
CMS’ assumption that patients who need this type of equipment would
be able to determine when maintenance or repairs would be required
and to arrange for these services.

According to the association, “These patients suffer from
progressive terminal conditions that affect their ability to fill
their lungs. Their conditions can vary from stable to rapidly
regressive and can change from stable to rapid regression in short
periods of time. They are at high risk for respiratory failure. To
maintain their safety and health status, these patients require
frequent monitoring, adjustment and service that would not be
available under the capped rental payment category.”

Cynthia Gray, RRT, vice president of respiratory and HME for
Oklahoma City-based CV Medical Solutions, said that with the
change, she is concerned about patient safety, especially because
the agency doesn’t explain how it will pay for emergency calls and
repair of equipment. “They say they’re going to do it, but there is
no provision made to take care of it,” she explained.

Gray said a portion of CPAP patients–3 percent at CV Medical
Solutions–are on CPAPs with the backup feature, which will breathe
for them if they stop breathing on their own. Such patients range
from those who only use the machine at night to those who use it 12
or more hours a day.

Although she doesn’t think the rule will affect the average
user, it is a serious concern for those with special needs, such as
neuromuscular patients or those with a tracheostomy, Gray said.
“Unless CMS makes a provision that they will pay for clinical
follow-up of these patients, you’re going to have an increased
number of [emergency room] and hospital visits,” she said.

The CPAP also needs to be serviced every year, she continued.
“Either the patient pays for it or they don’t,” she said. “If it’s
not done, there could be subsequent death.”

Since 1992, RADs with a backup rate feature have been paid by
Medicare on a continuous monthly rental basis. The change is being
made in an attempt to save millions of dollars after an HHS Office
of Inspector General report found that the RADs do not require
frequent servicing. The OIG reported that supplier services consist
mainly of routine maintenance and patient monitoring. “While other
types of RADs have been paid correctly as capped-rental devices,
the RADs with a timed backup feature were incorrectly categorized,”
CMS said in its announcement.

According to CMS, beneficiaries will pay less out of pocket as a
result of the changes. They are now paying up to $128 a month in
coinsurance, but that rate will drop to $96 starting in the fourth
month of the rental and be eliminated altogether after the 13th
month when patients assume ownership of the device.

The rule only applies to RADs and not ventilators, CMS
noted.

To view the rule, published in the Jan. 27 Federal
Register,
click here.