Why it IS illegal - sort of - to change your pressure.

[idamtnboy]

I agree and even think that POSSIBILITY is very remote. Insurance companies care about compliance. If accused, most people would claim a machine malfunction anyway, or claim it was accidental.

Some of the docs, DME's, R.T.'s I have dealt with are too busy to tell me what I need to know (had to learn it all here) let alone have time to check that I have changed pressure or not (even though doc said I could).....BUT he did that at MY SUGGESTION -- again, based on what I have learned here.

And then there is Medicare, who may actually have a "big brother" watching me. Since my machine is being paid for by Medicare as primary insurer, I have to send the SD card in to the provider periodically so they can monitor compliance. Now would they pay that close attention to the pressure and notice that I changed it on my own, who knows. I doubt it, but the clear possibility is there that they would. I'm sure at the least they would raise a question. Probably the data goes to my doctor who may well be monitoring reasonably closely. In my case if I think the pressure needs to be changed I would want to play it safe and call the Dr's office to ask about doing so.

[Tielman]

Take interstate commerce first. The act as a whole is clearly aimed at manufacturers and sellers, not consumers. Look at those subsections above. They revolve around references to delivery, payment, and commerce. The rest of the act is the same way. Historically, the FDCA was a consumer protection measure growing out concerns about contaminated food and drugs, not misuse by individuals.

Unfortunately, the federal appellate courts have ruled that "interstate commerce" does not require crossing state boundaries as most people would think. Locally produced products sold in the local market (even those not going beyond 10 miles within a state) are STILL subject to the "interstate commerce" clause. Fortunately, it still only applies to the company SELLING and RENTING of devices, and not the end consumer.

The issue here is the same as the one that FBI warning you see at the beginning of your DVD. It only applies to "sales" and "volume copying" and not to personal copying, thus there is no reason to have it on a personally owned DVD that you aren't going to be selling. It's complete and utter BS that has no bearing on the law, and meant to confuse and distract, and especially scare you from making a backup copy of your DVD. The MPAA would have you believe that if you invite someone over to watch a DVD you are violating the copyright law and should pay for a second copy of the DVD.

FACT: Did you know that a restaurant can be fined and successfully sued if it's employees sing "Happy Birthday" without a ASCAP license to do so? Technically it's illegal to do for ANY gathering.

[SleepingUgly]

And then there is Medicare, who may actually have a "big brother" watching me. Since my machine is being paid for by Medicare as primary insurer, I have to send the SD card in to the provider periodically so they can monitor compliance. Now would they pay that close attention to the pressure and notice that I changed it on my own, who knows. I doubt it, but the clear possibility is there that they would. I'm sure at the least they would raise a question. Probably the data goes to my doctor who may well be monitoring reasonably closely. In my case if I think the pressure needs to be changed I would want to play it safe and call the Dr's office to ask about doing so.

What does medicare require to pay for a machine? One month of using it for 4 hours each night, or something else?

[DoriC]

We were asked once to bring in our card to the DME after 30 days so they could download the compliance data to have on record "in case" Medicare requested it from them. I had already changed pressures on my own and they had no interest in that at all.

[allen476]

We were asked once to bring in our card to the DME after 30 days so they could download the compliance data to have on record "in case" Medicare requested it from them. I had already changed pressures on my own and they had no interest in that at all.

The RT at the DME I use checks not only compliance but all of the other data on the card when I send it in. I had changed my pressure shortly after receiving my new Bi-PAP and she noticed it immediately. She called my PCP to find out why. Luckily I had informed my PCP that I had changed it and she was fine with it and relayed to the RT it was a change she made. The RT called me to find out where I had the pressure change done. I told her that I did it myself. She didn't even raise a stink because she knows that I am about 2 hours by car to get to there.

Allen

[PST]

Take interstate commerce first. The act as a whole is clearly aimed at manufacturers and sellers, not consumers. Look at those subsections above. They revolve around references to delivery, payment, and commerce. The rest of the act is the same way. Historically, the FDCA was a consumer protection measure growing out concerns about contaminated food and drugs, not misuse by individuals.

Unfortunately, the federal appellate courts have ruled that "interstate commerce" does not require crossing state boundaries as most people would think. Locally produced products sold in the local market (even those not going beyond 10 miles within a state) are STILL subject to the "interstate commerce" clause. Fortunately, it still only applies to the company SELLING and RENTING of devices, and not the end consumer.

I agree that the courts have found Congress's power to regulate interstate commerce to be surprisingly broad. If Congress ever wanted to pass a law forbidding the adjustment of CPAP pressure settings, accompanied by a finding that unregulated pressure twiddling is detrimental to a safe and orderly interstate trade in used CPAP equipment, it might be able to get away with it. Fortunately, the FDCA makes no attempt to do that. I think Tielman and I agree on this.

FACT: Did you know that a restaurant can be fined and successfully sued if it's employees sing "Happy Birthday" without a ASCAP license to do so? Technically it's illegal to do for ANY gathering.

I agree that the restaurant can be successfully sued. It isn't because of any federal overreaching under the commerce clause, though. Article I gives Congress full power over copyrights, and the rights granted to songwriters include public performance. The current owners of the copyright on "Happy Birthday" contract with ASCAP, a voluntary organization of copyright holders, to license the performance rights. There is a specific exception in section 110 of the Copyright Act for non-commercial performances where no one gets paid and no admission is charged. So it's okay to take Grandma out for ice cream and sing Happy Birthday to her as long as the waiters don't join in. They can't sing because they're getting paid.

[idamtnboy]

And then there is Medicare, who may actually have a "big brother" watching me. Since my machine is being paid for by Medicare as primary insurer, I have to send the SD card in to the provider periodically so they can monitor compliance. Now would they pay that close attention to the pressure and notice that I changed it on my own, who knows. I doubt it, but the clear possibility is there that they would. I'm sure at the least they would raise a question. Probably the data goes to my doctor who may well be monitoring reasonably closely. In my case if I think the pressure needs to be changed I would want to play it safe and call the Dr's office to ask about doing so.

What does medicare require to pay for a machine? One month of using it for 4 hours each night, or something else?

I think my provider said the card data has to show a daily average of 4 hrs + for each month or they won't keep paying for it. I took that to mean that you would be complying if you used the machine 8+ hrs every other night. I'm averaging well over 7 hrs/night so I haven't concerned myself with the specifics. According to the benefit statement I just received, Medicare will pay rent for 13 months for DME, then you own the machine. Supposedly if it breaks they will pay for a replacement with no hassle. I think the provider rep said Medicare pays rent for only 6 months for a CPAP though, then you own it.