The Centers for Medicare & Medicaid Services (CMS) this week published a notice in the Federal Register that affects sleep disorders facilities and patients who use CPAP therapy for obstructive sleep apnea. According to "Medicare Program; Revisions to Payment Policies Under the Physician Fee Schedule and Other Revisions to Part B for CY 2009; and Revisions to the Amendment of the E-Prescribing Exemption for Computer Generated Facsimile Transmissions; Proposed Rule" CMS created this rule to ensure payment systems are updated to reflect changes in medical practice and the relative value of home health patient’s POC.

Read an excerpted version of the notice online: According to the notice, CMS is, "proposing to 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 OSA." As such, CMS is "proposing to revise the DMEPOS supplier enrollment safeguards set forth at $424.57 to protect the Medicare program and its beneficiaries from fraudulent or abusive practices that may be related to CPAP devices." In the notice CMS also proposes new definitions for "sleep test" and "CPAP device" and the addition of new language that would establish specific payment prohibition as described in the first sentence.

It is important to consider this proposed rule from multiple angles. Implementation of such a rule certainly affects sleep facilities that administer CPAP devices to patients as a therapy for OSA and has an impact on their budget. However, implementation of such a rule also prevents DME suppliers and other parties with a strictly fiduciary interest in sleep medicine from offering sleep tests and limits the potential for fraud and abuse.

Also, it is important for members to note that this affects Medicare beneficiaries only, though private carriers may adopt similar policies in the future.

There is an open comment period on this proposed rule, and instructions on how to submit a comment follows:
Refer to file code CMS-1403-P and include the caption "OTHER ISSUES-SLEEP TESTS" at the beginning of your comment.

1.  Electronic comments may be submitted via Follow the instructions for "Comment or Submission" and enter the file code CMS-1403-P.

2.  Comments may be sent by mail to the following address:
Department of Health and Human Services
Attn: CMS-1403-P
P.O. Box 8013
Baltimore, MD 21244-8013

3.  Comments may be sent by overnight mail to the following address:
Department of Health and Human Services
Attn: CMS-1403-P
Mail Stop C4-26-05
7500 Security Blvd.
Baltimore, MD 21244-1850

Please note the comment period is 60 days, effective June 30.

The American Academy of Sleep Medicine will keep members abreast of developments regarding this policy.