Encouraging CMS to Support In-Home Treatment of Chronic Respiratory Failure Related to COPD

October 28, 2024

The American College of Chest Physicians (CHEST) recently provided public comment to the Centers for Medicare and Medicaid Services (CMS) in support of access to in-home noninvasive positive pressure ventilation for the treatment of chronic respiratory failure related to COPD.

This is a pertinent issue for CHEST membership—comprising 22,000 pulmonary, critical care, and sleep medicine clinicians—as it ensures that the therapies and interventions that clinicians prescribe will be appropriately accessible to their patients without challenge.

In its formal letter to CMS, CHEST drew on recommendations from its landmark 2021 Technical Expert Panel Report on Optimal NIV Medicare Access Promotion to provide input for CMS’ national coverage analysis for “Noninvasive Positive Pressure Ventilation in the Home for the Treatment of Chronic Respiratory Failure consequent to COPD” (tracking number: CAG-00465N).

The recommendations include:

• Removal of the requirement for overnight oximetry saturation measurement. It has no medical basis, is not physiologically sound, and, as oximetry measurement is inaccurate for dark skin tones, also exacerbates health disparities.
• Supply of a bilevel positive airway pressure device with backup rate or home mechanical ventilator for patients with chronic respiratory failure consequent to COPD without requiring trial of other devices.
• Creation of a comprehensive path forward that considers the system as a whole, enabling provision of the right device to the right patient at the right time.

Read the full letter to CMS.