Since issuing a 2001 decision memo, CMS has educated that ventilators are decidedly distinct from Respiratory Assist Devices (RAD). The memo’s backdrop compared RAD for Chronic Obstructive Pulmonary Disease (COPD) to invasive ventilation administered through an intubated airway. It further established that ventilators should be utilized when “failure of respiratory support leads to death”. These seven words severely limit the application of ventilator coverage and have guided MAC ventilator coverage decisions since the issuance of the memo.
Without directly saying so, CMS continues to quietly reassess the coverage guidance for ventilators. Adapting these educational materials to acknowledge the overlap of disease groupings between RAD and ventilators, while acknowledging that treatment plans for these patients will vary based on specifics in each case, are significant milestones.
We will be talking through this update and other behind the scenes issues impacting ventilator suppliers on June 8th with HME News. Reserve your seat for this event here.