Contractors yank new sleep rules

Tuesday, September 30, 2008

WASHINGTON--Sleep providers in August caught a break when the DME MACs delayed the Sept. 1 start date of the new local coverage determinations (LCDs) for positive airway pressure (PAP) devices.

“It appears they are going to rewrite the policy,” said Kelly Riley, director of The MED Group’s National Respiratory Network. “There were pieces that were so different from the national coverage determination, they had to withdraw it.”

In March, CMS released a national coverage determination for PAP devices, and in July, the four DME MACS released LCDs that went above and beyond. They included a host of new coverage criteria for PAP devices, including a 12-week compliance requirement for patients.

When they were released, the LCDs had industry stakeholders scrambling to re-open discussion, said Walt Gorski, vice president of government affairs for AAHomecare.

“With the LCDs, we were concerned that the policies were more than just a clarification of the national coverage determination,” he said. “We felt they required public input because of how drastically they would have changed the CPAP marketplace.”

Chief among AAHomecare’s concerns: The LCDs contain “significant new and very detailed coverage criteria that restrict access to PAP therapy.”

“We’re concerned about the impact on patients and providers,” said Gorski.

Also submitting comments to the four MACs was the American Association of Respiratory Care (AARC), which took issue with a requirement that patients prove compliance after 12 weeks in order to receive continued coverage for PAP devices.

In its comments, the AARC stated: “This policy is akin to a physician telling patients who suffer from respiratory illnesses that he or she can no longer prescribe a nebulizer to control their breathing disorders because they have not been using it as prescribed.”