Don’t expect CMS to remain silent on vents, Stark says

Friday, July 1, 2016

COLUMBIA, S.C. – CMS is not done tinkering with coverage guidelines for vents, predicts consultant Andrea Stark.

Discussing the National Association for Medical Direction of Respiratory Care’s recent request that CMS reconsider its national coverage determination for vents, Stark said during a recent webcast: “CMS is not obligated to agree or institute any changes. However, in light of many ‘quiet’ changes behind the scenes, we do not expect CMS to remain silent on ventilators.”

NAMDRC’s request asks CMS to delineate distinct coverage guidelines for vents and bi-level devices. The agency has tried to address this issue in a number of ways over the past year, most recently with a joint publication from the DME MACs removing the so-called “imminent death requirement” for vents.

Not satisfied, NAMDRC, comprised of physicians working in 2,000 hospitals nationwide, asks CMS to: 1.) establish specific clinical definitions for chronic respiratory failure, as well as mechanical ventilator and ventilation; 2.) recognize specific categories of mechanically ventilated patients that acknowledge chronic respiratory failure may occur intermittently, nocturnally or on an ongoing basis; and 2.) meld the current LCDs for “respiratory assist devices” into the revised NCD for vents with three notable changes (use terminology recognized by the medical community, and eliminate current requirements for oximetry testing in certain scenarios and failing therapy without a backup rate).

Stark calls NAMDRC’s request “sound” and “logical.”

Among the quiet changes that lead Stark to believe CMS will change coverage guidelines for vents is an “unofficial” decision by the DME MACs in jurisdictions C and D to discontinue medical reviews for the product category.

In response to NAMDRC’s request, CMS is now likely moving through a series of internal reviews and discussion periods. If it agrees changes need to be made, it will publish a proposed decision memorandum for public comment via the Federal Register.

Stark says CMS could respond to the request sometime in September.

In the meantime, Rep. Charles Boustany, R-La., a cardiovascular surgeon, plans to introduce legislation to “walk back” reduced reimbursement for vents until CMS completes this rulemaking, Stark says.