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 resolu-
tion referred to as ‘‘NPPVs’’), and clinically these pa-
•HCON 138 IH
tients need frequent and substantial servicing which adds
quality and productivity to their lives;
Whereas the Health Care Financing Administration (here-
after in this concurrent resolution referred to as
‘‘HCFA’’) coded NPPVs in 1992 into the frequent and
substantial servicing payment category under the medi-
care 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 sepa-
rate 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 serv-
icing 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 (relat-
ing 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 Con-
ference; and
(2) medicare payment for NPPVs should con-
tinue in the frequent and substantial service cat-
egory 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 pre-
scription for a prerequisite trial of 2 or 3 months
using a different device before the doctor can pre-
scribe an NPPV for patients with severe respiratory
diseases; and
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(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.
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