A technical expert panel has published recommendations that could help expedite national coverage determinations for optimal noninvasive ventilation and inform related policies for respiratory care and Medicare access.

The results could ensure that long-term care residents, among others, get quick access to lifesaving treatments, panelists said.

The American College of Chest Physicians Health Policy and Advocacy Committee, which first met in October 2020, was created to respond to growing concerns that potentially lifesaving noninvasive ventilation options were being denied payment. The problem is exacerbated by “rigid criteria” in local coverage determinations and coverage provided by Centers for Medicare & Medicaid Services that does not reflect the rapidly evolving technology in the field, CHEST said.

To address the problem, CHEST launched an advocacy initiative for respiratory care called the Optimal NIV Medicare Access Promotion, or ONMAP.

The resulting report reviews CMS coverage determinations for the delivery of noninvasive ventilation therapy to Medicare beneficiaries. The report’s five focus areas aim to enable access to improved treatment for people with disorders including thoracic restrictive disorders, chronic obstructive pulmonary disease, central sleep apnea, hypoventilation syndromes and obstructive sleep apnea.

“CMS was wanting rigorous scientific support necessary to clarify the ‘reasonable and necessary’ role of these new mechanical therapeutic modalities where there was none in order to move forward,” said Peter C. Gay, M.D., a critical care specialist at the Mayo Clinic and an HPAC committee member.  

“What we have done is create a pathway to simplify the maze of regulation and perhaps most importantly, remove the obstacles that currently exist,” he explained. 

LTC residents may benefit

Long-term care residents are among those who may benefit greatly from the resulting recommendations, Gay told the McKnight’s Clinical Daily. Patients who require mechanical ventilation are often medically fragile, so timing and streamlined approvals are key to optimal health outcomes, he and his colleagues explained. 

“For long-term care facilities that are beholden to Medicare payment, the work of this panel is critical to ensure that patients qualify for the device that will help them the most,” Gay said. 

The panel was conducted by CHEST, the American Academy of Sleep Medicine, the American Association forRespiratory Care and the American Thoracic Society.

The recommendations were published in the journal CHEST.