CMS, MACs Mum on CPAP Payment, Coverage Policies
ATLANTA–Two weeks after the local coverage determination for PAP devices was to have been implemented and the comment period closed on payment policy for CPAPs, CMS and its jurisdictional DME MACs remain silent on what, if any, changes might be made to either controversial policy.
As of Friday, neither the American Academy of Sleep Medicine nor the American Association for Homecare had received a response to letters objecting to proposed changes in the Medicare Part B physician payment policy for CPAP reimbursement as outlined in CMS-1403-P, or to the LCD.
“We have not yet received a formal reply from CMS,” said Kathleen McCann, director of communications for AASM, which noted its objections to the payment rule in a letter to the Department of Health and Human Services.
Among other stipulations, CMS-1403-P would “prohibit payment to the supplier of the CPAP device when such supplier, or its affiliate, is directly or indirectly the provider of the sleep test that is used to diagnose a Medicare beneficiary with [obstructive sleep apnea].”
AASM said it is concerned that such a policy would inhibit access to sleep testing and recommended that rural providers be exempted from the rule. In addition, it requested that sleep disorder facilities accredited by the AASM be exempt from the policy.
The two exemptions “will prevent an access issue and also serve as an assurance of quality care for patients,” Mary Susan Esther, M.D., president of AASM, asserted in the letter.
AAHomecare also voiced objections to the payment policy, saying “the proposed rule would limit appropriately trained and qualified DMEPOS suppliers’ ability to furnish home sleep tests to Medicare beneficiaries.”
The association called the provision “unnecessarily restrictive” and said it “created barriers to care that undermine the recent CMS national coverage determination on the use of CPAP devices to treat individuals with OSA diagnosed using home sleep testing.”
“There are access-related issues,” said Walt Gorski, vice president, government affairs, for AAHomecare.
The comment period for the physician payment policy ended Aug. 28.
“A final physician payment rule for 2009 comes out right around Nov. 1,” said Gorski, “so we will have to see whether the policy was stripped from the physician payment rule or whether they revised it or moved forward with it in November.”
Earlier, AAHomecare had sent the DME MACs an 11-page letter outlining objections to the new LCD covering CPAPs, but has not heard back on that, either.
The Sept. 1 implementation date for the LCD was delayed after industry stakeholders said they were blindsided by the DME MAC policy, which prohibited HME providers from conducting home sleep tests. The policy was published without going through a public comment period.
“We were very concerned with this policy as we believe it made new policy recommendations without appropriate notice and comment,” Gorski said. “We believe that the approach that the LCD put forth would harm access, therapy and raise various concerns.”
In its letter, the association charged that the LCD “contains significant new and detailed coverage criteria that restrict access to PAP therapy and limit who is eligible to furnish diagnostic test interpretations, which are Medicare-covered services.”
Gorski said he had no idea what action, if any, will be taken on the policy. “We believe that a new policy will be issued as soon as November, but we have no confirmation for that,” he said. “We still do not know if that would be open to a comment period.”
The DME MACs have said only, “A revised LCD will be published in the near future and will include a new effective date for those criteria.”
OUR DIGITAL PARTNERS