Medicare Fistula Coverage

In September 2021, 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.

CMS has reported back that they are unable to make any administrative changes to address this problem and have instructed us that Congress would need to make a change to statute to address the issue. WOCN is now considering next steps on this issue which could include engaging Congress..