IV

106TH CONGRESS

1ST SESSION H. CON. RES. 138

Expressing the sense of the Congress concerning the adverse impact of the

current administration Medicare payment policy for noninvasive positive

presssure ventilators on individuals with severe respiratory diseases.

IN THE HOUSE OF REPRESENTATIVES

JUNE 22, 1999

Mr. TOWNS submitted the following concurrent resolution; which was referred

to the Committee on Commerce, and in addition to the Committee on

Ways and Means, for a period to be subsequently determined by the

Speaker, in each case for consideration of such provisions as fall within

the jurisdiction of the committee concerned

CONCURRENT RESOLUTION

Expressing the sense of the Congress concerning the adverse

impact of the current administration Medicare payment

policy for noninvasive positive presssure ventilators on

individuals with severe respiratory diseases.

Whereas patients with severe respiratory diseases are the

sickest of the sick;

Whereas severe respiratory diseases are the third leading

cause of death;

Whereas many of these patients use noninvasive positive

pressure ventilators (hereafter in this concurrent resolution referred to as ‘‘NPPVs’’), and clinically these pa-
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tients need frequent and substantial servicing which adds

quality and productivity to their lives;

Whereas the Health Care Financing Administration (hereafter in this concurrent resolution referred to as

‘‘HCFA’’) coded NPPVs in 1992 into the frequent and

substantial servicing payment category under the medicare program;

Whereas in 1993 Congress codified and reaffirmed in specific

amendments to the Social Security Act that NPPVs

should be retained in that payment category;

Whereas the Food and Drug Administration’s 1995 Guidance

for Ventilators determined that NPPVs belong in a separate and distinct category from respiratory assist devices

which are used to treat less sick patients with sleep

apnea in the capped rental category under the medicare

program;

Whereas the clinical criteria agreed upon at the 1998 NPPV

Consensus Conference reinforced and substantiated the

long standing clinical practice of providing frequent and

substantial service for NPPV users;

Whereas for more than 7 years, all of the actions of HCFA

and the Durable Medical Equipment Regional Carriers

(in this concurrent resolution referred to as ‘‘DMERC’’)

under the medicare program agreed with and backed the

payment of NPPVs in the frequent and substantial servicing category;

Whereas any attempt by HCFA to change NPPVs from the

frequent and substantial servicing payment category to

the capped rental payment category requires the advance

approval of Congress; and
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Whereas the DMERC’s June 1, 1999, Medical Policy on

NPPVs includes 2 last minute material additions (relating to prerequisite trials and carbon dioxide levels) which

were not subject to review and comment and which are

inconsistent with the clinical guidelines agreed to by the

country’s leading respiratory physicians at the 1998

NPPV Consensus Conference: Now, therefore, be it

1 Resolved by the House of Representatives (the Senate

2 concurring), That (a) it is the sense of the Congress

3 that—

4 (1) the DMERC’s June 1, 1999, Medical Policy

5 on Individuals With Severe Respiratory Diseases,

6 particularly the provisions described in subsection

7 (b), should conform fully to the clinical criteria

8 agreed upon at the 1998 NPPV Consensus Con9 ference; and

10 (2) medicare payment for NPPVs should con11 tinue in the frequent and substantial service cat12 egory until otherwise provided by Act of Congress.

13 (b) The provisions described in this subsection are

14 provisions that—

15 (1) require physicians to write an off-label pre16 scription for a prerequisite trial of 2 or 3 months

17 using a different device before the doctor can pre18 scribe an NPPV for patients with severe respiratory

19 diseases; and
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1 (2) deny NPPV coverage for patients with

2 chronic obstructive pulmonary disease unless they

3 have carbon dioxide levels below 55 millimeters of

4 mercury and they have a sleep oximetry test which

5 shows sustained oxygen saturation levels below 88

6 percent.

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