July 20, 2022

Grassroots Call-to-Action on Oxygen Medical Necessity Documentation

Deadline to Support Congressional Sign-On Letter is July 29

Reps Terri Sewell (D—AL) and Larry Bucshon, MD (R—IN) are spearheading a Congressional letter to CMS asking that they streamline medical necessity documentation to protect patient access for home oxygen therapy.  This would make a huge impact for the HME industry and we need all members who provide oxygen services to get involved!  AAHomecare, VGM and HME state/regional associations are collaborating on this effort but it’s the voice of the local provider that matters!

The “ask”!  The Congressional sign-on letter requests CMS to:

  • Establish a clear set of objective criteria to support medical necessity;
  • Require contractors to rely solely on the Standard Written Order to establish medical need;
  • Eliminate the medical record review.

What you need to do: 

  • E-mail the staffer that deals with health care issues for your federal House legislator, and ask that they sign the Congressional letter to CMS.  If you need contact information, please email Gordon at AAHomecare at gordonb@aahomecare.org or the AAH/VGM Grassroots Accountability Project (GAP) team (Emily & Ashley) here for assistance.
  • Copy Kam Yuricich, OAMES executive director, at kam@oames.org in your email(s) to legislators and she’ll echo your “ask” for support on behalf of OAMES.
  • The deadline to join the letter is Friday, July 29, so please act quickly!

Key points to share in your emails/communications to legislator(s):

  • Per CERT data, less than 1% of Medicare home oxygen therapy claims are improperly paid are due to failing to meet medical necessity requirements.
  • Suppliers are caught in the middle when claims aren’t paid because they are required to provide equipment since it meets Medicare’s medical necessity requirements, yet the contractors deny claims for the clinicians’ notes not meeting the contractor’s standards.
  • The solution is to remove the ambiguity by creating clear rules and forms that facilitate beneficiary access while protecting against fraud and abuse.  
  • Precedence has already been set with success!  Pandemic flexibilities temporarily removed the requirement for medical record notes to be used to document medical necessity and instead use the prescription and standard written order.  
  • Endorsing stakeholders include several leading clinical and consumer organizations as well as AAHomecare, VGM, and CQRC.  Attached here is the joint letter to CMS from leading HME and respiratory advocates supporting this issue in October 2021.  

Need assistance?  Have questions?

  • If you have any questions about the letter, the “ask”, or your contacts with Congressional offices, please contact your HME advocacy team:  Gordon at AAHomecare at gordonb@aahomecare.org, the AAH/VGM Grassroots Accountability Project (GAP) team (Emily Harken and Ashley Plauché) here or Kam Yuricich at OAMES at kam@oames.org.  We’re here to help!