AAH, ALS association send NIV letter to CMS

WASHINGTON – AAHomecare and the ALS Association continue to press their case with CMS that Medicare Advantage plans are improperly denying claims and imposing stricter coverage criteria for non-invasive ventilators than Medicare allows. 

In an Oct. 4 letter to Kathryn Coleman, director, Medicare Drug & Health Plan Contract Admin Group for CMS, AAHomecare and the ALS Association share examples of MA plans that are “ignoring physician's orders and instead use excessive prior authorization requirements, requiring ‘fail first’ on respiratory assistance devices (RAD) for patients that need an NIV device and, in some instances, outright denying NIV to ALS patients.” 

The associations say the letter drives home the fact that NIVs are designed and approved by the U.S. Food and Drug Administration to treat chronic respiratory failure (CRF), while RADs are designed and approved to treat sleep apnea. The letter also cites peer-reviewed research showing that NIV use significantly reduces mortality and health care spending in Medicare patients with chronic respiratory failure. 

In June, AAHomecare and the ALS Association met with CMS and asked the agency to issue a memorandum clarifying medical policy and coverage of NIVs, as well as to take steps to expedite authorizations for people living with ALS.