WASHINGTON – Dropping CMN’s requirement for home oxygen without ensuring objective measures are in place to support the need for therapy could expose providers to denial and endanger patient access said Crispin Teufel, president of the Council for Quality Respiratory Care.
“We appreciate the expansion of oxygen coverage, but at the same time there are some things that worry us, like the subjectivity to which suppliers are subjected by contractors and appeals for judgment,” he said.
In July, CMS released a proposal to determine national coverage for home oxygen therapy which, among other things, expands access to acute conditions and removes the requirement for CMN. The CQRC * responded with a statement outlining its concerns.
If CMS eliminates CMN, it must implement clear objective measures, such as prescriptions or oxygen models, rather than relying on what is written in the medical record, Teufel explains.
“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 appears to invalidate oximetry testing in favor of arterial blood gas testing, which must be performed in a medical facility, which could be out of reach for many patients.
“This is what you don’t want to do if you want to create health equity,” he said. “There may be transportation issues or payment obligations. It (impacts) communities of color and it is not the right answer. We are concerned that this may snowball where MACs should have GBS results. ”
Other proposed changes are a welcome step in the right direction, says Teufel.
“Expanding coverage to acute patients, eliminating alternative treatment measures, eliminating the requirement for chronic stable condition – all of that is great,” he said. “What we learned during the pandemic is that acute patients can really benefit from oxygen and it’s great that CMS has recognized this in the long term.”