AAHomecare Submits Comments on CMS IFR

After thanking CMS for relief given to providers to help them continue providing services during COVID-19, association sought further clarification and recommended additional relief.

The American Association Homecare submitted its public comments on the Interim Final Rule (IFR) that CMS released at the end of March

The IFR provided several pieces of DMEPOS relief, such as a relaxation of clinical indications in National Coverage Determinations (NCDs) and Local Coverage Determinations (LCDs) for coverage of respiratory, home anticoagulation management and infusion pump.

CMS accepted public comments on the IFR until June 1 and AAHomecare submitted its comments, as well as its thanks to the agency for the relief the IFR provided, at the end of last week. Key points the association’s comments covered:

  • 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 three and/or 12-month recertification occurs during the public health emergency (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 judgment 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 more than 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. 

AAHomecare’s full comments are available as a downloadable PDF.

 

About the Author

David Kopf is the Publisher and Executive Editor of HME Business and DME Pharmacy magazines. Follow him on Twitter at @postacutenews.

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