Medicare contractor Palmetto GBA recently released revisions to its local coverage determination (LCD) policy for polysomnography and other sleep studies for Medicare Jurisdictions J and M (L36593), affecting sleep facilities in 7 states: Alabama, Tennessee, Georgia, North Carolina, South Carolina, Virginia and West Virginia. Effective March 8, 2018, sleep facilities in these jurisdictions must have sleep-specific accreditation to be eligible for coverage.
While Palmetto GBA previously required accreditation, general hospital accreditation through the Joint Commission that included the hospital-based sleep lab was sufficient for facilities that fell into this category. The LCD now states:
“In order to perform the technical component (TC) of PSG and sleep testing (including HST), the following must be met: The sleep center or laboratory must maintain documentation on file that indicates it is accredited by either: the American Academy of Sleep Medicine (AASM), OR the Accreditation Commission for Health Care (ACHC), OR the Ambulatory Care Accreditation Program of the Joint Commission. This documentation must be available on request. The AASM, ACHC, or Joint Commission accreditation applies to the hospital and freestanding facilities (including sleep clinics that are part of a physician’s office, and all other non-hospital-based facilities where sleep studies are performed. Diagnostic testing performed in an Independent Diagnostic Testing Facility (IDTF) must follow the supervision and credentialing guidelines set forth by CMS and/or Palmetto GBA.”
Facilities seeking accreditation because of the LCD revision qualify for the AASM’s Expedited Accreditation program for sleep facilities impacted by recent changes to Medicare coverage policies for sleep studies. Depending on a facility’s responsiveness and the thoroughness of its application, the AASM may be able to issue an accreditation decision 2 to 4 weeks after application submission.
To request participation in the expedited accreditation program, or for more information, sleep facilities can contact the AASM Accreditation Department at 630-737-9700 or firstname.lastname@example.org.