Technical Expert Panel on Optimal NIV Medicare Access

OCTOBER 2020

Technical Expert Panel on Optimal NIV Medicare Access

Encouraged by the proceedings of the Medicare Evidence Development and Coverage Advisory Committee’s (MEDCAC) July 22 meeting on home noninvasive ventilation (NIV), a TEP was formed to document scientific evidence pertaining to the use of various types of noninvasive positive pressure ventilation (NIPPV) equipment to best support patients with chronic respiratory failure.

Important changes in clinical practice and pertinent new evidence are available to apply to a reevaluation of reimbursement criteria that have interfered with appropriate delivery of equipment to Medicare beneficiaries, leading to reduced quality of life for too many patients. HPAC members Peter Gay, MD, MS, FCCP, and Lisa Wolfe, MD, FCCP, participated in the MEDCAC event, covered in the August issue.

Through the organizational efforts of CHEST’s HPAC, a wide-ranging assembly of experts convened virtually on October 3 and 4 to develop documents that will be presented to CMS as well as in a peer-reviewed journal to support reimbursement decisions to best serve patients’ needs in optimizing quality of life for those who need home oxygen. In addition to clinical experts representing professional societies including the American Academy of Sleep Medicine, American Thoracic Society, and the American Association for Respiratory Care, patient organizations, health-care information technologists, manufacturers, and other stakeholders are involved in the process.

The group is working rapidly to develop not only evidence-based documents for presentation to CMS, but will develop a template for an NCD with reimbursement criteria relevant to the evolving technology and capabilities of home mechanical ventilation equipment.

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