Tag: Non-invasive ventilators
In brief: Protect indie pharmacies, comment on NIV decision, fill sleep education gaps
March 14, 2025HME News Staff
WASHINGTON – A group of senators has introduced legislation to limit what they say are abusive pricing practices by pharmacy benefit managers.
The “Protecting Pharmacies in Medicaid Act,” introduced by Sens. Peter Welch, D-Vt., Roger Marshal, R-Kan., Mark Warner, D-Va., and Bill Cassidy, R-La., cracks down on what they call “spread pricing” - charging Medicaid more than PBMs charge pharmacies for a drug, driving up costs for Medicaid and short-changing pharmacies....
CMS seeks comment on NIV decision
March 12, 2025HME News Staff
WASHINGTON – CMS has released a proposed decision in response to the request for reconsideration of NCD 280.1 to establish coverage policies for the use of noninvasive home mechanical ventilators and respiratory assist devices for Medicare beneficiaries with COPD.
Read CMS’s proposed decision here.
The decision, according to AAHomecare, includes expanded coverage for RADs - with and without a backup rate feature - and home mechanical ventilators. Notably, the association...
In brief: Hurricane waivers, NIV advocacy, CRT lobby
October 4, 2024HME News Staff
WASHINGTON – CMS will permit people with Medicare who have lost or had damage to their DMEPOS products because of Hurricane Helene to receive replacements of such items and services, according to a bulletin from AAHomecare.
Specifically, CMS waivers for Florida, Georgia, North Carolina, South Carolina, and Tennessee state that:
When DMEPOS is lost, destroyed, irreparably damaged, or otherwise rendered unusable, CMS is allowing DME MACs to have the flexibility to waive...
AAH strengthens NIV, CGM advocacy
October 3, 2024HME News Staff
WASHINGTON – AAHomecare has expanded its relationship with legal and public policy firm Foley Hoag to strengthen its advocacy work on significant coverage issues for non-invasive ventilators and continuous glucose monitors. “Foley Hoag’s expertise in Medicare and Medicaid policy is already helping us sharpen our arguments by identifying established laws and regulations that support our advocacy goals,” said Tom Ryan, president and CEO of AAHomecare. “In addition, their...
NIV reconsideration: Try-and-fail recommendation causes concerns
September 27, 2024Theresa Flaherty, Managing Editor
WASHINGTON – Industry stakeholders are concerned that a recommendation to require COPD patients to try and fail on respiratory assist devices before they can qualify for non-invasive ventilators will impede access for patients.
The recommendation is part of a request to reconsider the national coverage determination for the use of non-invasive ventilators and respiratory assist devices for Medicare beneficiaries with COPD.
It would be better to first deal with existing issues...
CMS seeks input on NIV
September 12, 2024HME News Staff
WASHINGTON – CMS is soliciting public comment on a request for reconsideration of NCD 280.1 to establish coverage policies for the use of noninvasive home mechanical ventilators and respiratory assist devices for Medicare beneficiaries with COPD.
The scope of the agency’s national coverage analysis (NCA) is limited to noninvasive positive pressure ventilation in the home for the treatment of chronic respiratory failure consequent to COPD and will focus on clinical indications...
AAH seeks end user input on NIV, CGM
September 5, 2024HME News Staff
WASHINGTON – AAHomecare has launched two portals to collect end user and family caregiver stories about the impact of policy changes for non-invasive ventilators (NIVs) and continuous glucose monitors (CGMs). The association will use these stories in advocacy efforts to educate payers and governmental agencies on access issues and proposed solutions. "As we advocate for access to medically necessary equipment in the home, it is important for payers and government officials to understand...
In brief: AAH analyzes NIV data, Roche enters CGM market
July 12, 2024HME News Staff
WASHINGTON – AAHomecare is leading an effort to quantify the differences in outcomes and overall treatment costs for patients with significant respiratory challenges who receive non-invasive ventilation (NIV) therapy versus those who don’t. The research will help to determine the benefits of this therapy using CMS’s own data, potentially providing authoritative data to underpin advocacy to strengthen patient access to NIV, the association says. “This important effort stems...
Lincare settles FCA allegations
February 19, 2024HME News Staff
NEW YORK – Lincare will pay $25.5 million to resolve claims that it violated the False Claims Act by fraudulently continuing to bill federal health care programs for the rental of non-invasive ventilators that patients no longer needed or used.
The settlement also resolves claims that Lincare violated the Anti-Kickback Statute by waiving coinsurance payments to induce certain Medicare and Tricare beneficiaries to rent NIVs.
As part of the settlement, Lincare also...
AAH, ALS association send NIV letter to CMS
October 12, 2023HME News Staff
WASHINGTON – AAHomecare and the ALS Association continue to press their case with CMS that Medicare Advantage plans are improperly denying claims and imposing stricter coverage criteria for non-invasive ventilators than Medicare allows.
In an Oct. 4 letter to Kathryn Coleman, director, Medicare Drug & Health Plan Contract Admin Group for CMS, AAHomecare and the ALS Association share examples of MA plans that are “ignoring physician's orders and instead use excessive prior...