CMS publishes rule proposing prior authorization for CPAP

On May 28 the Centers for Medicare & Medicaid Services (CMS) published a proposed rule recommending a prior authorization process for certain durable medical equipment, prosthetics orthotics and supplies (DMEPOS). The rule identifies a “master list” of DMEPOS items of a certain price point that are frequently subject to unnecessary utilization – both CPAP and RAD are identified on the master list. CMS will implement prior authorization for a limited number of DMEPOS items from the master list.

The rule provides some insight into how the proposed prior authorizations will be reviewed and approved. Prior authorization will be granted based on compliance with established national and local coverage, coding and payment rules. A standard authorization request will take ten business days to process and an expedited authorization request can be obtained in two business days for more equipment required more immediately. 

Combined with the impact of the Competitive Bidding program, prior authorization is likely to cause significant access to care issues for Medicare patients with OSA. The AASM will submit comments to the proposed rule prior to the July 28 comment deadline. We will also continue to keep members updated about implementation of this rule in future editions of the Weekly Update. 

2014-05-29T00:00:00+00:00 May 29th, 2014|Clinical Resources|