CMS moves forward with proposal to expand home use of oxygen

Sunday, December 25, 2005

BALTIMORE - CMS announced Dec. 20 that there's sufficient evidence to expand the use of home oxygen for certain beneficiaries participating in approved clinical trials.

The agency proposed Aug. 16 expanding the use of home oxygen to beneficiaries with arterial oxygen partial pressure measurements in the range of 56 to 65 mmHG or whose oxygen saturation is at or above 89%. The current criteria, in effect for 12 years, covers beneficiaries with measurements at or below 55mmHG or saturation below 88%.

At that time, CMS sought comments to determine if there was sufficient evidence to make the change, and it received input from 16 respiratory therapists, associations, physicians and other healthcare professionals. The majority of comments supported expanding the use of home oxygen.

The agency now seeks a second round of comments before it makes a final determination.

At least initially, CMS would expand the use of home oxygen only to beneficiaries enrolled in approved clinical trials. Currently, for example, the National Institutes of Health (NIH) is seeking proposals for research on whether certain patients are being under treated for oxygen therapy, said Joe Lewarski, vice chairman of AAHomecare's HME/RT Council.

"One of the questions that came up is who's going to pay for the oxygen for the patients who get selected to be in the study group," he said. "One of the answers was to expand the Medicare home oxygen criteria for patients who are enrolled in a clinical study."

The NIH's research could be groundbreaking, industry sources say. Until now, there has been little research conducted on the effects of long-term oxygen therapy (LTOT) for patients with measurements in the range of 56 to 59 mmHG.

One study, the Nocturnal Oxygen Therapy Trial (NOTT) study, found that patients with measurements of 56 to 59 mmHG "should also be considered for LTOT." The therapy could prevent the condition of these patients, especially those with co-morbid diseases, from worsening, industry sources said.

If CMS expands the coverage criteria for all beneficiaries with measurements in the range of 56 to 65 mmHG--regardless of their participation in a clinical trial--the number of oxygen users would increase by about 5%, according to industry estimates.