More pressure mounting on HCFA to reverse NPPV policy

By MATTHEW HAY

HHBR Washington Correspondent

WASHINGTON – House Commerce Committee Chairman Rep. Tom Bliley (R-VA) gave Health Care Financing Administration (HCFA; Baltimore) Administrator Nancy-Ann Min DeParle a set of detailed questions last week regarding the agency’s proposed change in reimbursement category for non-invasive positive pressure ventilation (NPPV) devices and set a July 22 deadline for her to respond.

HCFA has proposed moving NPPV devices from the frequent and substantial servicing category to the capped rental category. But that proposal has drawn a firestorm of protest. Bliley said his committee has received "substantial and credible complaints" that HCFA’s proposed change would create public health risks and is contrary to federal law. He said these complaints have included "leading physicians with years of experience treating patients with noninvasive ventilation" and asked DeParle to reconcile HCFA’s position with these clinical experts.

Last month, Rep. Edolphus Towns (D-NY) offered a resolution criticizing the proposed change and demanding that HCFA rescind the requirement that physicians write an off-label prescription for a prerequisite trial of two to three months using a different device before the physician can prescribe an NPPV device.

At a HCFA Town Hall meeting on this subject last month, Don White, first vice chair of the National Association for Medical Equipment Services (Alexandria, VA), argued that the policy released by the durable medical equipment carriers that would redefine NPPVs as "respiratory assist devices" circumvents the plain language of the statute. According to White, NPPVs must be monitored closely, including frequent review of the patient’s oximetry, lung sounds, blood pressure, and respiratory rate. "Moreover," he added, "the nature of the equipment itself requires regular calibration and maintenance checks."

White told a senior HCFA official present at the meeting that a typical protocol for patients who use NPPVs includes monthly follow-up visits for the first six months of therapy. "From a practical perspective, NPPV ventilators are ventilators that require frequent and substantial servicing," White said. "This has been clear to Congress, it is clear to the medical community, and hopefully it will become clear to HCFA." HCFA’s proposed change is currently slated to become effective Oct. 1, 1999.