Sleep stakeholders weigh in on CMS proposal

Sunday, September 7, 2008

BALTIMORE - The American Academy of Sleep Medicine (AASM) in August called a CMS proposal that would limit who could bill for CPAP "unnecessarily prohibitive and one that ultimately compromises patient care."

Under CMS proposal 1403-P, Medicare would not pay DME providers for a CPAP if the provider is affiliated directly or indirectly with the lab providing the sleep test. How the agency plans to define 'affiliate' is a major question among providers and other industry stakeholders.

While providers are already prohibited from performing sleep tests, many have partnerships with sleep labs, in which the provider refers a patient for a sleep study in exchange for the opportunity to provide CPAP if the patient is diagnosed with obstructive sleep apnea.

AASM said it supported any efforts to prevent fraud and abuse, and in comments submitted to CMS, AASM said that facilities accredited by AASM should be exempt from the proposed policy:

"(We are) unaware of fraud or abuse issues related to the distribution of CPAP ... at facilities accredited by the AASM."

Also weighing in was the American Sleep Apnea Association.

"The issue of durable medical equipment providers also providing the diagnostic testing for sleep apnea misses the more important point of how the Sleep Apnea patient will be managed, in order to achieve the best adherence to therapy, especially in the early stages of treatment," Executive Director Ed Grandi stated in a letter. "If the organization offering diagnostic services as well as providing the therapeutic equipment does so in the context of providing a disease management program for the benefit of the sleep apnea patient and can demonstrate they are providing a seamless continuity of care, then no restriction should be placed on their ability to provide both services."

The comment period on the proposal closed Aug. 29.