Lobby Efforts Ongoing To Have Respiratory Therapy Recognized By CMS

What happens outside the hospital setting

At the present time, respiratory therapy services are not recognized by the Centers for Medicare & Medicaid Services (CMS). Therefore, our services outside the hospital settings cannot be reimbursed for. This works to the disadvantage of both us RTs and the patients we serve.

In July of 1965, Medicare was created under Title XVII of the Social Security Act. It was signed into law by then President Lyndon B. Johnson. The act provided health insurance to people over the age of 65.

There are various professions that are listed under the bill. These include physicians, nurses, physical therapists, speech therapy, and occupational services. This made it so that any services provided by  these professionals was reimbursable by CMS.

This is why you see nurses in nursing homes but no respiratory therapists in nursing homes. This is why you see nurses working for home health care services, but rarely see respiratory therapists working for home health care services. This is why physical therapists can open up physical therapy clinics outside hospital settings, and you see no such respiratory therapy clinics.

So, basically, if it were not for these professions being recognized by CMS, these services would not be provided. Lacking these services, patients wouldn't get the ideal care after being discharged that they so deserve. This would have a negative impact on patient outcomes, and would negatively impact patient morbidity and mortality.

There was a push to have respiratory therapy added to the bill. However, despite respiratory therapy being an established profession by 1965, the profession was not listed on the bill. For this reason, respiratory therapists are only able to work in the hospital setting.

Yes, it was recognized that respiratory services might be needed outside the hospital setting. But, it was determined that our services could be just as easily be provided by nurses.

However, since that time various studies show that our profession is the best at teaching inhaler and nebulizer technique to the COPD and asthma populations. And that patients surely would benefit from our services outside the hospital settings. So, various organizations, such as the American Association for Respiratory Care (AARC) and the Allergy & Asthma Network, have been pushing for bills to recognize respiratory services.

Each year, the AARC and the Asthma & Allergy Network sponsor lobby weeks on Capitol Hill. Over the years they have sponsored various bills that would recognize our profession, thereby allowing our services to be funded outside the hospital setting.

A few years ago there were lobbying efforts to include respiratory therapy on the appropriations bill that funds the Department of Health and Human Services. This did not get through, but perhaps it will in the future.

In 2013, there was a bill called the Medicare Respiratory Therapist Access Act. If passed, this would have allowed for reimbursement for self management education for COPD patients by qualified respiratory therapists.

A bill introduced to the 116th Congress is H.R. 2508. This bill is called the "Breathe Act." If passed, would provide a pilot program to include respiratory therapists as telehealth practitioners under the Medicare Program. This bill doesn't go far enough, but at least it would be a start.

Sources.

1. "Whats our plan to get Respiratory Therapy service reimbursed by Medicare and Insurance for SNFs," COPD foundation. 
2. "Allergy & Asthma Network Urges Support For the Following Bills Before the 116th Congress," Allergy & Asthma Network. 
3. "Should Medicare Allow Respiratory Therapists To Independently Practice?" Chest Journal.