Officials from all four DME MACs announced that provisions from recent local coverage determinations (LCDs) on positive airway pressure (PAP) have been delayed. NHIC Corp, Cigna, and National Government Services made the announcement last week with Noridian following suit this week. “In July, the DME MACs published an LCD on PAP devices for obstructive sleep apnea. Some criteria in that policy were to take effect for dates of service on or after September 1,” the announcement stated. “All criteria with a September 1, 2008 implementation date are being delayed.”

For providers such as Helen Kent (pictured, top left), RRT, the move is a chance for the MACs to step back and look at ways to work with the new technology that she believes can increase access, reduce costs, and help more patients. “I am hopeful that the scope of the policies will be revised to more closely resemble the spirit of the national coverage determination,” said Kent, president of Progressive Medical, Carlsbad, Calif. “There have been lots of Items in the LCDs that were not previously addressed via a public comment process, especially the ‘G’ codes.”

Commenting on the LCDs, Christian Kiely (pictured, right), marketing manager, Fisher & Paykel Healthcare Inc, said, “The recent DME MAC PAP policies placed an enormous burden on homecare providers in terms of pre-study and adherence to therapy documentation. With today's announcement of the delays in the implementation of the policies, we are hopeful that the scope of the policies will be revised to more closely resemble the spirit of the National Coverage Determination. There were several items in the LCDs that were not previously addressed via a public comment process.”

Landon Pendleton, director of product development, Instant Diagnostic Systems Inc, agrees that lack of a public comment process is part of the reason for the delay. “I would think they would either scale back some of the newly introduced criteria and restrictions and/or open the LCDs up for comment.” Pendleton also attributed the delay to other factors, stating, “We feel the delay is in response to the massive amount of pushback on several controversial restrictions and new pieces in the latest iteration of the PAP LCD relating to HST and the new compliance criteria.”   

Part of that “massive” pushback was an extensive set of comments and questions submitted by AAHomecare, which included a specific request to delay implementation. Part of the 11-page document questioned the MAC’s rationale for choosing who may interpret test results. “It is not clear to us on what basis the DME MAC determined to limit who is qualified to interpret diagnostic sleep studies to only physicians board-certified in sleep medicine or active medical staff of sleep centers or labs that are Joint Commission or AASM accredited,” wrote AAHomecare officials in response to the LCD. “Medicare regulations contain specific requirements governing Medicare coverage and reimbursement rules for diagnostic tests, including sleep studies, but these regulations in no way limit who is qualified to interpret a test.”

According to AAHomecare, a revised LCD will eventually be published and will include a new implementation date.