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[Congressional Bills 106th Congress]
[From the U.S. Government Publishing Office]
[H. Con. Res. 138 Introduced in House (IH)]

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 patients 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
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
    Resolved by the House of Representatives (the Senate concurring), 
That (a) it is the sense of the Congress that--
            (1) the DMERC's June 1, 1999, Medical Policy on Individuals 
        With Severe Respiratory Diseases, particularly the provisions 
        described in subsection (b), should conform fully to the 
        clinical criteria agreed upon at the 1998 NPPV Consensus 
        Conference; and
            (2) medicare payment for NPPVs should continue in the 
        frequent and substantial service category until otherwise 
        provided by Act of Congress.
    (b) The provisions described in this subsection are provisions 
that--
            (1) require physicians to write an off-label prescription 
        for a prerequisite trial of 2 or 3 months using a different 
        device before the doctor can prescribe an NPPV for patients 
        with severe respiratory diseases; and
            (2) deny NPPV coverage for patients with chronic 
        obstructive pulmonary disease unless they have carbon dioxide 
        levels below 55 millimeters of mercury and they have a sleep 
        oximetry test which shows sustained oxygen saturation levels 
        below 88 percent.
                                 <all>
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