CQRC can’t support oxygen changes wholesale

WASHINGTON - Dropping the CMN requirement for home oxygen without ensuring there are objective measures in place to support the need for therapy could expose providers to claim denials and put patient access at risk, says Crispin Teufel, chairman of the Council for Quality Respiratory Care. 

“We appreciate the expansion of oxygen coverage, but at the same time, some things worry us, like the subjectivity to which providers are subjected to by contractors and judgment calls,” he said. 

CMS in *July issued a proposed national coverage determination for home oxygen therapy that, among other things, expands access for acute conditions and removes the CMN requirement. The CQRC *responded with a statement outlining its concerns. 

If CMS eliminates the CMN, it needs to implement clear objective measures, such as prescriptions or oxygen templates, rather than relying on what’s written in the medical record, says Teufel. 

“At the end of the day, if we have an objective measure, I don’t care about the CMN,” he said. 

Teufel is also concerned that the proposal seems to invalidate oximetry testing in favor of arterial blood gas testing, which must be performed in a medical facility, something that could be out of reach for many patients. 

“That is what you don’t want to do if you want to create health equity,” he said. “There can be transportation issues or payment obligations. It (impacts) communities of color and that’s not the right answer. We are worried this could snowball to where the MACs would have to have the ABG results.” 

Other proposed changes are a welcome step in the right direction, says Teufel. 

“Expanding coverage to acute patients, eliminating alternate treatment measurements, eliminating the chronic stable state requirement – all those are great,” he said. “What we learned during the pandemic is that acute patients really can benefit from oxygen and it’s great CMS recognized that for the long term.”