AAHomecare seeks clear guidance from CMS for patient care post-PHE
Friday, March 10, 2023

AAHomecare and oxygen stakeholders joined major respiratory associations in asking HHS to protect access to respiratory products for patients who qualified for care under relaxed guidelines during the COVID-19 Public Health Emergency (PHE).

 
In a letter to HHS Secretary Xavier Becerra, the group shared an industry estimate of more than 1 million Medicare beneficiaries who were prescribed respiratory products during the PHE and said, “it is not logistically possible given the current stresses in the health care system to expect all of these beneficiaries to visit their physicians and to be tested again” by the expected May 11 end-date for the PHE.
 
The stakeholders also seek: 

 

  • Grandfathering home oxygen, sleep therapy, and NIV non-invasive patients in terms of the qualification requirements that were in place during the pandemic.  We believe this policy is consistent with the guidance CMS provided as part of PHE flexibilities but still needs to be definitively affirmed.
  • CMS stipulates that any patient set up during the PHE who ended service during the PHE or within one year of the end of the PHE would not have their claims subject to a medical necessity audit.
  • Eliminating the medical record review and urging CMS to instead accept the clinician prescription/Standard Written Order as the required documentation for establishing medical necessity, as it does for other prescription medications.

"To protect access to home respiratory therapy, especially in underserved populations, it is imparrive that physicians, health care professionals and suppliers have a clear understanding of how Centers for Medicare & Medicaid Services (CMS) will transition those patients who began oxygen or others home respiratory therapies during the pandemic to post-pandemic documentation requirements," the letter read.


See the full letter from AAHomecare, American Association for Respiratory Care, American Lung Association, American Thoracic Society, Council for Quality Respiratory Care, Pulmonary Fibrosis Foundation, and VGM for more details.