Advocates Tell CMS NIPPV NCD Must Be Changed to Protect Patient Access

CMS/Medicare

WASHINTON—The Centers for Medicare & Medicaid Services (CMS) should delay its proposed national policy coverage determination (NCD) on noninvasive positive pressure ventilation (NIPPV) and make substantive changes or risk harming patient access, the American Association of Homecare said in public comments. 

In its 17-plus-page document, the advocacy group said that CMS needs to make the NCD consistent with medical practice, practical and implementable. Without modifications, CEO Tom Ryan wrote, the American Association of Homecare (AAHomecare) would prefer the existing national and local coverage determinations remain in place “to ensure that at least the current level of patient access is not further eroded.” 

“If CMS does not address the identified issues before finalizing the policy, it will likely severely impact current service levels and compromise beneficiary access to ventilation therapy that saves dollars and avoids costly hospital readmissions, while decreasing mortality rates,” the document reads. 

CMS received 199 public comments on the NCD, many of them from providers who said it would impair their ability to provide care. Many asked CMS to at least grandfather in existing patients or to leave current regulations as they are. 

“The proposed decision memo, as currently written, presents several clinical and operational challenges that would result in eligible patients discontinuing therapy—putting them at risk of hospitalization, health deterioration, or death,” wrote Kristin Kash, executive vice president of revenue cycle and compliance for DASCO HME. 

AAHomecare said that it has increased efforts in recent weeks to build industry consensus on the topic, both at CMS and on Capitol Hill. 

In advance of the Apr. 10 comment deadline, AAHomecare worked to develop aligned messaging with leaders from member respiratory companies and industry stakeholder groups. It also encouraged substantive comments from its membership and clinicians.

On April 10, AAHomeccare elctronically submitted a NIPPV NCA comment form which said the proposed NIPPV NCA would create unnecessary barriers to essential care due to overly prescriptive critieria that would impede with the “physician’s ability to exercise their medical judgement and ensuing requirements for durable medical equipment (DME) suppliers that are virtually impossible to comply with.”

On Apr. 7, AAHomecare and industry stakeholders met with leaders of the Coverage Analysis Group at CMS to share its concerns with the proposed NCD in person. AAHomecare’s Tom Ryan, Kim Brummett, Mina Uehara and General Counsel Cara Bachenheimer took part in the focused and productive session, along with representatives from CQRC and VGM. Bill Guidetti with Apria provided a respiratory company perspective, and Al Dobson presented findings from the recently completed Dobson DaVanzo study on the positive impacts of home-based NIV therapy for Medicare beneficiaries.

Ryan and Jay Witter were also on Capitol Hill last week to meet with physician members of Congress who could be effective, well-informed advocates for the industry’s concerns. Ryan and Witter met with Sens. John Cassidy (R-LA) and Roger Marshall (R-KS), and Reps. Mariannette Miller-Meeks (R-IA), Neal Dunn (R-FL), Greg Murphy (R-NC) and the Executive Director of the House Doctors Caucus. They also met with Rep. Morgan Griffith (R-VA), a senior member of the House Energy & Commerce Health Subcommittee, and attended an event that included most of the North Carolina congressional delegation.

Given the potential impacts on patient health that could follow from implementing the provisions in the NCD, AAHomecare said it will continue to engage CMS and Capitol Hill on this issue to help arrive at NIPPV coverage, testing and administrative processes that allow the DME industry to deliver the most effective care to individuals with significant respiratory challenges.

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