Stakeholders Applaud Introduction of Safeguarding Medicare Access to Respiratory Therapy Act of 2019

Washington, D.C. (November 4, 2019) — A coalition of patient, clinician, and provider groups – including the ALS Association, the American Association for Respiratory Care (AARC), the National Association for Medical Direction of Respiratory Care (NAMDRC), American Association for Homecare (AAHC), and the Council for Respiratory Care (CQRC) – today commend Representatives Morgan Griffith (R-VA) and Peter Welch (D-VT) for introducing legislation to protect Medicare beneficiaries’ access to critical home ventilation therapy. The Safeguarding Medicare Access to Respiratory Therapy (SMART) Act of 2019 would delay the inclusion of ventilators from the Medicare durable medical equipment competitive bidding program for five years, and establish a technical expert panel (TEP) to update that national coverage policies for home mechanical ventilator devices so that they reflect technological advancements and peer-reviewed science.

“The life expectancy for people with ALS is very short and most eventually die of respiratory failure. Until we find treatments and a cure for ALS, people living with ALS must have access to life-saving noninvasive ventilators (NIV) so they can stay at home with their families and out of institutions,” said Calaneet Balas, President and CEO of The ALS Association. “The Medicare program’s plan to competitively bid NIV will drastically harm access to these medically necessary devices and the clinical care provided by respiratory therapists. It must be stopped so people with ALS can live longer lives and live with their families. The ALS Association urges Congress to immediately pass this legislation to protect access to home non-invasive ventilators for people living with ALS.” 

Earlier this year, the Centers for Medicare and Medicaid Services (CMS) announced that it would include noninvasive ventilators in the next round of competitive bidding. Representatives Griffith and Welch, joined by 178 of their House colleagues, urged CMS to reconsider this move as, “ventilators are highly specialized and care-intensive devices that allow fragile, medically complex patients to remain in their home,” and, “even brief delays in access to clinical ventilator support can prove dangerous or even fatal and would likely mean patients are no longer able to receive their care at home.” The SMART Act directs CMS to revise outdated home mechanical ventilation policies to reflect evidence-based modern medicine, ensuring patients receive the right device at the right time. 

“Based on their clinical expertise, respiratory therapists play a critical role in assessing and managing the treatment of individuals who depend on non-invasive ventilatory support in their home. The SMART Act will ensure this much-needed clinical support is not compromised and we applaud Reps. Griffith and Welch for taking action to protect fragile patients who would otherwise be at risk based on CMS’ decision,” said Karen Schell, President of the American Association for Respiratory Care. “The requirement that CMS convene a technical expert panel to fix outdated coverage policies for home mechanical ventilation that have led to unnecessary utilization and to which AARC and other pulmonary organizations have repeatedly pressed CMS to revise is a critical piece of this legislation.”

Unlike all other types of equipment subject to competitive bidding, ventilators require constant vigilance and adjustments as a patient’s needs change. That is why, by statute, they require “frequent and substantial servicing in order to avoid risk to the beneficiary’s health.” Medicare reimburses for this frequent and substantial servicing on a monthly basis with a single payment inclusive of the device, all related supplies, servicing and maintenance, and in-home respiratory therapy. The groups support the SMART Act as they believe that revising the coverage policies, as the legislation directs, should precede any action to subject patients on NIVs to the competitive bidding program. Until the competitive bidding program reforms prove to be effective in yielding sustainable rates, this unique payment structure risks discouraging the supply of appropriate care to medically complex patients.

“NAMDRC’s mission is to remove legislative and regulatory barriers to access to care, and there is unquestionable evidence that moving forward with inclusion of home mechanical ventilation in competitive bidding will have significant adverse impact on access to this life sustaining therapy,” ​said Phil Porte, Executive Director. “This legislation will take important steps to eliminate these barriers."

This coalition calls on Congress to promptly consider and pass the SMART Act in order to thwart the harm that including ventilators in Medicare’s competitive bidding program is expected to inflict on patients. 

About The ALS Association 
The ALS Association is the largest private funder of ALS research in the world. The Association funds global research collaborations, provides assistance for people with ALS and their families through its nationwide network of chapters and certified clinical care centers, and advocates for better public policies for people with ALS. The ALS Association builds hope and enhances quality of life while urgently searching for new treatments and a cure. For more information about The ALS Association, visit our website at

About the American Association for Homecare 
AAHomecare advocates for home medical equipment providers and manufacturers in Washington, D.C., as well as with state Medicaid authorities and other major payer groups. Their efforts include lobbying to ensure sustainable reimbursement rates and sensible regulatory policy for the HME community at the Federal and state level. Learn more at

About the American Association for Respiratory Care 
Founded in 1947, the American Association of Respiratory Care (AARC) is the leading national and international professional association for respiratory care. We encourage and promote professional excellence, advance the science and practice of respiratory care, and advocate for patients, their families, the public, the profession, and the respiratory therapist. Supporting more than 47,000 members worldwide, the AARC is a not-for-profit professional association headquartered in Irving, TX. Learn more about us at

About the Council for Quality Respiratory Care 
The Council for Quality Respiratory Care (CQRC) is a coalition of the nation's seven leading home oxygen therapy provider and manufacturing companies. To learn more visit http://www.cqrc.organd follow CQRC on Twitter at @TheCQRC.

About the National Association for Medical Direction of Respiratory Care 
Established over three decades ago, the National Association for Medical Direction of Respiratory Care (NAMDRC) is a national organization of physicians whose mission is to educate its members and address regulatory, legislative and payment issues that relate to the delivery of healthcare to patients with respiratory disorders. NAMDRC members, all physicians, work in close to 2,000 hospitals nationwide, primarily in respiratory care departments and critical/intensive care units. For more than a quarter of a century NAMDRC has emphasized quality patient care. The Association is dedicated to providing support for pulmonologists and other physicians who provide clinical and management leadership in respiratory, critical care and sleep medicine. Learn more at

For more information, contact:
Brian Frederick 
The ALS Association
(202) 464-8612