CMS expands home oxygen use for certain bennies

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Sunday, March 26, 2006

WASHINGTON - CMS made a final determination March 23 that it will expand the use of home oxygen for Medicare beneficiaries participating in an approved clinical trial sponsored by the National Heart, Lung & Blood Institute.

As part of the trial, oxygen therapy will be provided to beneficiaries with arterial oxygen partial measurements of 56 mmHg to 65 mmHg or oxygen saturation at or more than 89%.

CMS currently covers beneficiaries with arterial oxygen partial measurements of 55 mmHg or less or oxygen saturation less than 88%. If certain diseases/conditions are present, the agency covers beneficiaries with measurements of 56 mmHg to 60 mmHG or saturation of 89%.

"This is an important opportunity to improve the care of our seniors, and to get better evidence on how doctors and patients can achieve the best outcomes for this serious and hard to treat condition," said CMS Administrator Mark McClellan in statement.

The final determination ensures funding for all clinical items and services needed by patients enrolled in the trial.

Until now, there has been little research conducted on the effects of long-term oxygen therapy (LTOT) for beneficiaries with measurements of 56 mmHg to 59 mmHg.

One study, the Nocturnal Oxygen Therapy Trial (NOTT) study, found that patients with measurements of 56 mmHg to 59 mmHg "should also be considered for LTOT," but the study involved a small test group. LTOT could prevent the condition of these beneficiaries, especially those with co-morbid diseases, from worsening, industry sources said (See HME News February 2006).

There's no indication, at this point, that CMS plans to expand the coverage criteria for beneficiaries not participating in a clinical trial, sources said.

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