The American Association for Respiratory Care (AARC) recently expressed disapproval with CMS’ nebulizer draft local coverage determination and has officially submitted written objections to the proposal. The AARC released the following statement summarizing the associations position: This week the AARC submitted extensive comments to CMS calling for them to withdraw proposed changes to their nebulizer policies that would reduce the payment for levalbuterol to the payment allowance for albuterol. CMS is proposing, through its Durable Medical Equipment Program Safeguard Contactors (DME PCS), that payment of levalbuterol be lowered based on their conclusions that there is no medical difference between the two drugs and, therefore, Medicare should pay the lower reimbursement rate associated with albuterol. The draft local coverage determination to change the payment for levalbuterol is based on the DME PCS’ assertion that the medical necessity for levalbuterol has not been established. The AARC’s review of the scientific literature upon which the decision is based shows just the opposite. We are also recommending that the DME PCS work with AARC and other stakeholders to draft specific criteria upon which levalbuterol has been shown to be effective and for which payment can be made at the 2006 payment allowance.