Medicare proposal: Changing Sleep Apnea diagnosis criteria

betty303 · Post by **betty303** » Sat Dec 22, 2007 5:29 pm

I just found this in the SNOOZE NEWS section of Dr. Krakow's webiste (http://sleeptreatment.com) about a proposal from Medicare to make some changes in the requirements for options to diagnose sleep apnea, and requirements for compliance.

http://www.medicalnewstoday.com/articles/92430.php

Interesting info about expanding the possibilities for diagnosis beyond a PSG (and lowering the time requirements for 2 continuous hrs of sleep !).

I was disturbed by the limit of only 12 weeks of coverage unless you could prove compliance to the CPAP treatment - as a person who struggled through 10 + months of not being compliant on any regular basis before I could show some success - where would I be if I could not get coverage for the machine and getting new masks to try (still on that search !)

Unfortunately the links at the end of th article for public response led to no where.

Anyone have more info?

Bearded_One · Post by **Bearded_One** » Sat Dec 22, 2007 6:15 pm

I don't know if it is related; there was a recent proposal by the Centers for Medicare and Medicaid Services to allow at-home diagnosis of sleep apnea.

http://www.stuff.co.nz/stuff/sundaystar ... a6470.html

There must be some rationale for the 12 week number. I wonder if any studies have been done showing how many people who are not compliant after 12 weeks are compliant after 12 months.

betty303 · Post by **betty303** » Sat Dec 22, 2007 7:26 pm

Bearded one -

Yep - they are related. CMS is who announced the proposal. I am not sure who the proposal goes to and where the decision lies - but on the whole, it sounds like they are getting more realistic - saying things like people with severe sleep apnea can't sleep for continuous 2 hours, so they need to prove severe AHI, but the time requirement - they are saying is too stiff.

alv7722 · Post by **alv7722** » Sun Dec 23, 2007 12:25 am

If this means what I think it does, its about time. I was denied therapy on an emergency basis just because the sleep quack wanted to hold me up for a "titration" study. Aside from the $1400+, I think I would be either dead, injured in an autor accident, or at the very least, would have lost my job if I hadn't found a way around the "protocol". I just could not wait another 45 days to get help! I really wish the quack had been willing to work with me, but with the info on this forum, I can do it myself.

betty303 · Post by **betty303** » Mon Dec 24, 2007 10:09 am

I just read Slinky's post from Bloomberg about possible Fisher & Paykel buyout and at the end of the article, saw this....

"The stock has also been helped by a DECISION by the Centers for Medicare & Medicaid Services to extend public Medicare coverage to sleep apnea devices on Dec. 20, Walker said. ``That is pretty significant in terms of their growth going forward,'' he said.

To contact the reporter on this story: Emma O'Brien in Wellington on eobrien6@bloomberg.net

Last Updated: December 23, 2007 22:10 EST"

Maybe the CMS proposal is a DECISION that has already been implemented, rather than a proposal that has a process to go through.

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