Proposal tightens CPAP policy

Sunday, July 20, 2008

WASHINGTON - Under a new proposal, Medicare would not pay DME providers for a CPAP if the provider is affiliated directly or indirectly with providing the sleep test.

"Affiliated is the wild card here," said Clay Stribling, an attorney with Amarillo, Texas-based Brown & Fortunato. "We are hoping that they give us a more detailed definition of affiliate, but I think we can assume that would include some common ownership-type relationships where the individual that owned the sleep lab owned the DME."

Medicare policy already prohibits providers from providing the test and the equipment, but as long as the sleep lab and the DME are separate legal entities, it's permissible.

"Presumably, this would close that loophole and eliminate some of the common owner relationships," said Stribling. "It all depends on how they define affiliate. There are a lot of contractual relationships out there between DMEs and sleep labs."

CMS is accepting comments on the proposal until Aug. 29. Comments may be submitted at Follow the instructions for "Comment or Submission" and enter the file code CMS-1403-P.