Home Health & Hospice Week

Switch will impact neuromuscular patients negatively, experts warn.

Respiratory suppliers have been dealt another capped rental blow--this time for certain respiratory assist devices.

Effective April 1, some RADs will be changing classifications. RADs with a backup rate feature that delivers air pressure when the user's breathing becomes insufficient "will no longer be considered durable medical equipment (DME) requiring frequent and substantial servicing for payment purposes," the Centers for Medicare & Medicaid Services says in a Jan. 26 release. Instead they'll move to the capped rental category.

After renting a RAD for 13 months, beneficiaries will take ownership of the equipment, CMS points out. This is a change from current coverage, under which Medicare pays monthly rental fees for RADs as long as the beneficiaries need the device. The agency first proposed this change in September 2003 (see Eli's HCW, Vol. XII, No. 30).

Changes May Hurt Patients

Beneficiaries pay up to $128 per month in coinsurance for their RADs. When the new rule goes into effect, their coinsurance costs will decrease to $96 a month, effective the fourth month of rental, CMS says in the release.

"While other types of RADs have been paid correctly as capped rental devices, the RADs with a timed backup feature were incorrectly categorized and paid under the payment category for items that require frequent and substantial servicing," CMS says in the release. The HHS Office of Inspector General determined these RADs do not require frequent service that would justify continuous rental payments, CMS says.

Watch out: But suppliers fear the change could bring big problems for patients.

"Our biggest concern has been neuromuscular patients," says Jacki McClure, a respiratory therapist who directs the Lubbock, TX-based MED Group's  respiratory network.

These patients include those with ALS or Lou Gehrig's disease. They need the backup rate RADs and will no longer receive the assistance of a respiratory therapist to help them with the service once they own the equipment under capped rental, McClure says.

CMS based the proposal to place RADs in the capped-rental category on its conclusion that non-invasive positive pressure ventilators, now known as RADs, "are merely respiratory assist devices with a back-up rate and not true ventilators," protests the American Association for Homecare.

But NPPVs/RADs are true ventilators, AAH blasts. "They are used to treat conditions in which the patients cannot fill their own lungs because the lung tissue functions abnormally or the ability to fill the lungs is impaired," the trade group maintains. "In contrast, RADs without a back-up rate are used to bypass an upper airway obstruction so that patients with conditions such as obstructive sleep apnea can fill their otherwise normal lungs."

As true ventilators, CMS should keep these RADs in the frequent and substantial servicing and not capped rental category, AAHomecare laments.

Switch Could Sting Small Suppliers

On the horizon: Bigger companies with a diversified patient base will most likely continue to offer RADs in the new capped rental environment, McClure predicts. Smaller companies will be more likely to feel the pinch, she says.

RADs currently being rented to beneficiaries will go through a transition period as capped rental takes effect, CMS says in the release. During the transition, rental months paid prior to April 1 will not count toward the rental payment cap.