Today the American Academy of Sleep Medicine submitted a request to the Centers for Medicare & Medicaid Services, urging CMS to issue a Section 1135 waiver of the positive airway pressure (PAP) requirements for in-person clinical re-evaluation. A waiver is necessary to help reduce potential exposure to the novel coronavirus (COVID-19) among older adults, who have a higher risk of serious illness from COVID-19.
On March 13, President Trump issued a proclamation declaring that the COVID-19 outbreak in the United States constitutes a national emergency. This declaration includes authorization to temporarily waive or modify certain requirements of the Medicare and Medicaid insurance programs throughout the duration of this public health emergency. A CMS fact sheet posted on March 13, COVID-19 Emergency Declaration Health Care Providers Fact Sheet, indicates that contractors have the flexibility to waive the face-to-face requirement for the replacement of DME that is lost, destroyed, irreparably damaged, or otherwise rendered unusable. The AASM is requesting that CMS extend this waiver to include the requirements for in-person PAP follow-up visits.
The Local Coverage Determination (LCD) for Positive Airway Pressure (PAP) Devices for the Treatment of Obstructive Sleep Apnea (L33718), which applies to all jurisdictions and states, requires “in-person clinical re-evaluation by the treating practitioner” for continued coverage of a PAP device for the treatment of obstructive sleep apnea (OSA) beyond the first three months of therapy. However, in cities where community transmission of COVID-19 is substantial, the mitigation strategies of the Centers for Disease Control and Prevention (CDC) recommend that health care providers “cancel elective and non-urgent procedures” to reduce facility-based transmission.
The AASM is encouraging CMS to consider waiving the requirements for in-person clinical re-evaluation, allowing postponement of these visits, or allowing telemedicine visits so that sleep medicine providers can minimize the risk of COVID-19 exposure for Medicare beneficiaries without jeopardizing continued coverage of PAP therapy.
The AASM has encouraged the American Medical Association (AMA), American College of Chest Physicians (CHEST), American Thoracic Society (ATS), Philips, and ResMed to contact CMS in support of this request.
To learn more, please contact the AASM at firstname.lastname@example.org.
**UPDATE – March 17: Today CMS announced that it is dramatically expanding access to Medicare telehealth services so that beneficiaries can receive a wider range of services from their doctors without having to travel to a health care facility. CMS is expanding this benefit on a temporary and emergency basis in response to COVID-19. Medicare patients may use telecommunication technology for office, hospital visits and other services that generally occur in-person. These visits are considered the same as in-person visits and are paid at the same rate as regular, in-person visits.
**UPDATE – March 19: Today the AASM sent a follow-up letter to CMS, continuing to urge CMS to issue a Section 1135 waiver of the requirements for clinical re-evaluation to maintain continued coverage for PAP therapy for the treatment of OSA and for annual DME re-supply orders. While the letter commended CMS for the recent announcement expanding Medicare telehealth coverage for beneficiaries during this national emergency, it noted that the reality is that some older adults have no access to the technology needed for a telehealth visit. Therefore, some older adults with no access to telehealth technology will have to choose between losing their coverage for PAP therapy or risking their health by making an in-person visit to their health care provider.
**UPDATE – March 20: Today the AASM sent a letter to private payers urging them to waive requirements for in-person clinical re-evaluations to maintain continued coverage for PAP therapy for the treatment of OSA.
**UPDATE – March 30: Today CMS announced sweeping, temporary regulatory changes to help address the COVID-19 patient surge, including the elimination of requirements for face-to-face or in-person encounters. During this public health emergency, CMS will not enforce the clinical indications for coverage for CPAP for OSA, allowing Medicare to cover CPAP devices based on the clinician’s assessment of the patient. Read the fact sheet for physicians and other clinicians and the interim final rule.
Updated Jan. 5, 2021