Fifteen Patients Who Can Be Helped by Medicare: Insurance Policy Changes in the Coverage of CPAP Therapy for Obstructive Sleep Apnea.

Neurol Clin Pract

Department of Neurology-Baystate Medical Center (KGJ), University of Massachusetts Chan School of Medicine-Baystate, Springfield; Department of Healthcare Delivery and Population Science (KGJ), University of Massachusetts Chan School of Medicine-Baystate, Springfield; and Department of Medicine (MR), Veterans Affairs Medical Center, Martinsburg, WV.

Published: February 2023

Insurance coverage policies define the diagnostic criteria and adherence requirements for patients to qualify for initial and ongoing therapy with continuous positive airway pressure (CPAP) treatment, the most complete therapy for obstructive sleep apnea. Unfortunately, a number of patients who use CPAP and benefit from treatment fail to meet these requirements. We present 15 patients who fail to meet Centers for Medicare and Medicaid Services' (CMS) criteria, highlighting policies that do not support patient care. Finally, we review expert panel recommendations to improve CMS policies, and we suggest ways that physicians can better support CPAP access within the current regulatory restrictions.

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Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9973292PMC
http://dx.doi.org/10.1212/CPJ.0000000000200118DOI Listing

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