CMS Releases Final NCD on Noninvasive Positive Pressure Ventilation

BALTIMORE, Maryland—The Centers for Medicare & Medicaid Services (CMS) announced it has released its final national coverage determination (NCD) for the treatment of chronic respiratory failure associated with chronic obstructive pulmonary disease (COPD). The NCD establishes for the first time Medicare coverage criteria for home mechanical ventilation (HMV); it also outlines coverage for respiratory assist devices (RADs). 

The memo lays out national coverage for: 

1. RADs with backup rate feature: CMS will over in the home a RAD with backup rate to deliver high intensity noninvasive ventilation (NIV) as treatment for chronic respiratory failure linked to COPD. This type of RAD is covered in the home for six months when several criteria are met. By the end of the six-month period, the RAD must be used as high intensity therapy.

2. RAD without backup rate feature: CMS will cover in the home a RAD without the backup rate feature for a patient with chronic respiratory failure linked to COPD if they cannot tolerate high intensity noninvasive ventilation (NIV) or the backup rate feature is otherwise medically inappropriate. Two criteria must be met.

Patients must be evaluated at least twice within the first year after initially receiving a RAD.

3. Home mechanical ventilators: CMS will cover an HMV used in a volume targeted mode as treatment for the same type of patient if several criteria are met.
Home medical equipment (HME) advocates, including the American Association for Homecare (AAHomecare), had previously said that components of the draft policy shared earlier this year would limit access to life-saving technology, including the requirements for evaluations every six months, some of the medical criteria and not specifically “grandfathering” in patients with existing devices.

Home medical equipment (HME) advocates, including the American Association for Homecare (AAHomecare), had previously said that components of the draft policy shared earlier this year would limit access to life-saving technology, including the requirements for evaluations every six months, some of the medical criteria and not specifically “grandfathering” in patients with existing devices.

AAHomecare, VGM and the Council for Quality Respiratory Care released this policy brief outlining problems with the proposal, which drew almost 200 public comments. 

AAHomecare also asked CMS for at least a year to institute a new NCD. 

AAHomecare said in an email to members June 9 that it is evaluating the final NCD.