Home Health & Hospice Week

CMS asks for evidence to support proposed policy change.

Home oxygen suppliers may soon be able to offer their wares to more Medicare beneficiaries.

In a hopeful development for the respiratory care industry, the Centers for Medicare & Medicaid Services is considering expanding coverage for home use of supplemental oxygen.

CMS issued a national coverage analysis Aug. 16 proposing to extend durable medical equipment coverage for patients with slightly higher arterial oxygen partial pressure measurements than those currently covered.

The current policy, in place since 1993, permits coverage of home oxygen for patients with oxygen partial pressure measurements at or below 55 millimeters of mercury or 88 percent oxygen saturation. It also allows coverage for patients at 56 to 60 mm Hg or 89 percent oxygen saturation if certain other diseases or conditions are present, such as congestive heart failure.

CMS has internally generated a national coverage determination reconsideration to assess whether there is sufficient evidence to expand the current policy to cover beneficiaries with partial pressure measurements in the range of 56 to 65 mm Hg.

"The medical literature documents health benefits as well as serious adverse events associated with supplemental oxygen use," CMS notes in its announcement. "In this light, [it] is clear that the decision to initiate, continue, or discontinue the use of supplemental oxygen should be guided by high quality scientific evidence."

Give your two cents: The agency is now seeking evidence to support the expanded coverage. It will accept public comments until Sept. 16, 2005, and it expects to issue a decision memo on Feb. 16, 2006.

The proposed change "certainly would bring some additional people in to the coverage criteria," observes Wayne Stanfield of the Halifax-based Home Care Alliance of Virginia. "But how many? That's going to be a hard number to figure out for awhile."

Of his approximately 180 oxygen patients, only about 5 percent qualify in the current policy's higher range, Stanfield reports. "Not all that many patients fall into this bracket," he says.

Note: For more details on the proposal and to submit comments online, go to www.cms.hhs.gov/mcd/viewtrackingsheet.asp?id=169.