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This announcement is largely through the efforts of Bob W and his organization.  Long overdue 

 

strikeouts appeared after posting not sure why   Admins feel free to adjust.

 

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Our community has been advocating hard since 2011 to reverse a CMS (Centers for Medicare & Medicaid Services) policy that did not allow for coverage of home use of oxygen as a treatment for Cluster Headache.  Someday we’ll recap all the steps involved in this long journey.
 
Today, we are here to report some long overdue good news. CMS has published their response to our appeal via a “Proposed Decision Memo”. They “propose to modify its NCD for Home Use of Oxygen at section 240.2 of the Medicare NCD Manual to expand patient access to oxygen and oxygen equipment in the home, and to permit contractors to cover the use of home oxygen and oxygen equipment in order to treat CH and other acute conditions.”
 
You can read the full text of the decision memo here. Also, reference the original NCD (National Coverage Determination) 240.2.2 and 204.2.  Within the decision memo, there is reference to the number and quality of comments received from the community back in 2020; Thank you to everyone who contributed.
 
One thing to be aware of, the proposed decision states that the Medicare Administrative Contractor (MAC) “may determine reasonable and necessary coverage of home oxygen and oxygen equipment for patients with conditions unrelated to hypoxemia.  Initial coverage for patients with conditions unrelated to hypoxemia is limited to the shorter of 90 days or physician prescription. Oxygen coverage may be renewed if medically necessary when a treating practitioner determines within 60-90 days after the DME has been initially placed in the home that the patient exhibits a continuing need for oxygen.”
 
This news is very new to us, so we are still absorbing and understanding it fully ourselves. We will share additional details as we better understand.

Sincerely, 

Katie MacDonald & The AHDA Team

 

 
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Edited by Pebblesthecorgi
Misspelled
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