CMS favors home sleep tests

Thursday, January 31, 2008

BALTIMORE - Coverage for home-based sleep tests inched closer to reality Dec. 13, when CMS recommended changes to its coverage criteria for CPAP.
Under current policy, OSA patients must be diagnosed in a sleep lab. Last March, the American Academy of Otolarynology-Head and Neck Surgery asked CMS to review its coverage policy for at-home tests.
The decision came as no surprise to industry leaders, but several of the proposed changes raised concerns. For example: Expanding overage to include Type IV devices, which offer only one or two channel studies and are less accurate than Type II and Type III devices.
"That's terrible," said Helen Kent, owner of Carlsbad, Calif.-based Progressive Medical. "They need a minimum of four or five channels."
Kent also spoke out against dropping the required minimum two hours of continuous recorded sleep. More time is needed for a patient to go through all four stages of the sleep cycle, she said.
Also raising eyebrows: The proposal suggests limiting initial CPAP coverage to 12 weeks.
"I think they are looking to see if the therapy is successful," said Dr. Robert Hoover, Cigna medical director. "But that raises the question of what kind of documentation it's going to take to certify that the therapy was successful."
Hoover predicted that the documentation requirement would ultimately be left up to the medical directors in each jurisdiction.
Furthermore, the proposal did not include information about home titration for CPAP--an important step in successful CPAP therapy, said Kent.
"You can't pick a pressure in a couple of hours," she said. "We have people titrating for weeks."
And finally, the proposal did not address perhaps the biggest question for HME providers: Who can conduct home sleep tests?
"There does need to be some level of oversight by a physician that has experience and training in sleep medicine," said Hoover. "I think there is a role for the HME provider to deliver the equipment and set it up, but not for interpretation."
CMS will continue to review public comments before making a final decision in March.