WASHINGTON, D.C. (May 27, 2020)—AAHomecare is currently working on comments for the Interim Final Rule (IFR), Medicare and Medicaid Programs; Policy and Regulatory Revisions in Response to the COVID-19 public health emergency that was published on April 6, 2020. This IFR provided relief on coverage for respiratory products and allows non-physician healthcare professionals to prescribe DME under Medicaid. You can find AAHomecare’s summary on the IFR here.
Although the IFR has been in effect since March 1, the Centers for Medicare & Medicaid Services (CMS) provides the public an opportunity to submit comments on the changes. AAHomecare is taking this opportunity to respond to the relief in the IFR and is requesting additional relief and clarifications that will help the HME community during and after this pandemic. Below are some key requests the association is including in their comments:
- Documentation to support the “reasonable and necessary” requirement for respiratory-related products during the PHE should include a physician’s standard written order (SWO) and documentation that the beneficiary has some type of respiratory-related acute or chronic condition.
- Provide clarification that all beneficiaries with an initial date of service during the PHE will continue to be covered under the medical review criteria in effect during the PHE, throughout that beneficiary’s period of medical need, as determined by the physician. In addition, any beneficiary on home oxygen therapy whose 3 and/or 12-month recertification occurs during the PHE, should be deemed to have met the medical necessity requirements in place during the PHE.
- Clarify in a FAQ that if a physician orders a CPAP for a beneficiary during the PHE, and there is some evidence of the beneficiary having a respiratory condition, then an initial sleep study is not required, and the claim would be deemed to meet the “reasonable and necessary” requirement.
- Provide written clarification in a FAQ that the physician does not need to have an in-person meeting with the beneficiary but can utilize his/her clinical judgement and review of the patient and his/her medical records to meet this requirement, for the duration of the PHE.
- Suspend the enforcement of the clinical conditions for coverage for hospital beds, as CMS has done for respiratory DME items, for the duration of the PHE.
- Instead of resuming TPEs that were in process as of the beginning of the PHE, CMS should cancel those TPEs. At the end of the PHE, CMS should instruct the MACs to begin new TPEs based on new data analysis.
- Postpone the implementation of Round 2021 DME competitive bidding program. AAHomecare’s member survey with over 500 respondents showed the impact of supply chain issues and drastic changes in workflow due to the pandemic that raises serious beneficiary access concerns for the next round.
For members interested in submitting comments, AAHomecare welcomes you to include the above-referenced points. Your comments are most meaningful when you share details about your company’s challenges during this PHE. We will be sharing our finalized comments with membership later this week. Please feel free to include our final comments as an attachment to your submission. Comments are due June 1 and should be submitted at regulations.gov.
