Medicare Fistula Coverage
In September, WOCN, UOAA, ASCRS, and industry met with officials at the Centers for Medicare and Medicaid Services (CMS) to discuss Medicare coverage of spontaneous fistula. WOCN members have expressed a growing concern over the lack of access to supplies for patients who have nonsurgical and surgical related fistula. These groups of patients are falling into a coverage gap that exists in post-acute, post home care with access to supplies. This issue has been noted in patients both pediatric and adult and more information can be found in a recently updated White Paper prepared by the Society.
In an effort to close this coverage gap WOCN has been working with other stakeholders to engage CMS in a conversation about how to change coverage policy so patients have access to these important supplies. This recent meeting is the first step in the process and we are hopeful that this advocacy will result in a change in CMS coverage policy to ensure access.
Next steps for the Society will be to engage a Member of Congress in our fight to expand fistula coverage and encourage that member to reach out to CMS for an update on this initiative.