ARLINGTON, Va. – AAHomecare and the ALS Association asked CMS to promptly issue a memorandum clarifying medical policy and coverage of non-invasive ventilators (NIVs) and take steps to expedite authorizations for people living with ALS.
They shared their concerns about reports of denials as high as 86% and 64% for two major MA plans, with rates in the low teens for other MA plans. They report issues for both new setups and continued authorizations.
“The ALS Association representatives and clinicians provided first-hand accounts of the devastating impacts that delays and denials can have on patients and their caregivers,” the association stated. “The advocates drove home the notion that physicians who have examined and made a clinical assessment of a patient are best positioned to determine the type of respirator needed – not MA plan prior authorization and utilization staff.”
AAHomecare representatives Tom Ryan, David Chandler and Cara Bachenheimer were joined by ALS Association representatives Kathleen Sheehan and Cynthia Knoche. Dr. Lisa Wolf and Dr. John Hansen-Flaschen, prominent physicians who treat ALS patients, also took part in the meeting. CMS was represented by its Deputy Director, Parts C and D, as well as the Director and Deputy Director of Drug and Health Plan Contact Administration.
Bid relief support
Twenty-five national, regional and state HME associations have joined AAHomecare in writing a letter in support of S. 1294, which would extend the 75/25 blended Medicare reimbursement rate for suppliers in non-rural, non-competitive bidding areas through the end of 2024.
In their letter to the bill’s original sponsors, Sens. John Thune, R-S.D., and Debbie Stabenow, D-Mich., the associations note that rising product and operational costs “are being shouldered by DME suppliers who continue receiving price increase notifications from their vendor partners, as well as increased delivery and operational costs, while facing fixed reimbursement rates.”
AAHomecare recommends that stakeholders use the letter when contacting senators to support the bill.
“We need to continue to press legislators to co-sponsor S.1294 in June and July and begin to build momentum for consideration later this year,” the association states. “Convincing Senators to co-sponsor legislation can be a challenging process but building a base of bipartisan support for the S. 1294 is critical for the bill’s consideration. Support from members of the Senate Finance Committee is especially important.”