ATLANTA--Weeks after tabling the Sept. 1 implementation date for the local coverage determination for PAP devices, the DME MACs last week issued a revised LCD that eased at least some of the restrictions included in their first version of the medical policy.

The newly revised LCD was greeted with measured enthusiasm from industry stakeholders who noted, among other things, that it revises coverage criteria for documentation of the initial evaluation and also the requirement for beneficiary education by the entity conducting a home sleep test.

It also extends the implementation dates for credentialing of physicians interpreting the HSTs and facility-based polysomnograms and expands the dates during which patients must be re-evaluated for documenting benefits from PAP therapy.

“It’s a much softer, kinder version,” said Kelly Riley, director of the National Respiratory Network for The MED Group, Lubbock, Texas. “Home sleep testing is back in.”

But HME providers hoping for the green light to perform HSTs were disappointed.

“It does not open the door for providers to do [home] sleep testing,” said Andrea Stark, a Medicare consultant with MiraVista LLC in Columbia, S.C. “It specifically says providers cannot be involved.”

Indeed, as stated in the originally issued LCD, the ruling is clear: “No aspect of an HST, including but not limited to delivery and/or pickup of the device, may be performed by a DME supplier,” it reads.

Stark said she was slightly disappointed in that mandate. “I think it is an unnecessary restriction. DME providers are uniquely prepared to do that kind of [delivery and pickup],” she said. “The whole thing was about accessibility for the patient.”

The newly revised version is the result of controversy over the earlier LCD, published without public comment on July 17. Set for implementation on Sept. 1, it followed CMS’ national coverage determination issued in March.

Stakeholders, however, raised numerous issues about the LCD, saying that it restricted access, particularly in rural areas, and was released without the benefit of public comment even though it contained numerous new policy mandates. In August, the DME MACs elected to postpone its implementation.

“Implementation was delayed until contractors (such as Cigna Government Services) received official notification from the Centers for Medicare and Medicaid Services of the new national coverage determination and instructions on what changes to implement,” explained Robert Hoover, M.D., medical director for Jurisdiction C. “Although a formal comment process was not required, the DME MAC medical directors received feedback from the provider community and delayed the implementation of certain provisions pending further review.”

Stark said even though the newly revised version also was not held up for public comment, “I think the changes are going to be livable for most providers.”

Walt Gorski, vice president of government affairs for the American Association for Homecare, which had questioned the absence of a public comment period, said the association was in the process of reviewing the new LCD to determine how suppliers can move forward under its terms.

Meanwhile, stakeholders applauded other provisions of the revised policy.

For example, providers can now document compliance either by “direct download from equipment or by visual inspection of adherence information,” the LCD says.

“The biggest thing that jumped out at me is that we can do a visual compliance reading to determine if the patient is really in compliance. That’s definitely a good thing,” said provider Patrick Clevidence, vice president of respiratory services for Medical Services Company in Cleveland, Ohio.

According to the LCD: “Documentation of adherence to PAP therapy shall be accomplished through direct download or visual inspection of usage data with documentation provided in a written report format to be reviewed by the treating physician and included in the beneficiary’s medical record. This information does not have to be submitted with the claim but must be available upon request.”

“You can actually get information from the hour meter; you don’t have to have a download. Before, you were actually going to have to buy the more expensive CPAP model, which, in some cases, can be $200 to $250 more,” Clevidence said. “Now, we won’t have to inconvenience the patient by having them send in their Smart card, have someone here download it, print out the information and send it out to the physician’s office.”