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CMS-1403-FC
The attended facility- based PSG testing paradigm may
include same night initiation and titration of CPAP
treatment. The final rule provides an exception for
attended facility-based PSG. Thus, we believe that the
exception provides a reasonable option should the
beneficiary’s treating physician determine that there is a
pressing need for urgent treatment in the case of an
individual beneficiary.
Comment: Several commenters believe that the adoption
of this rule would cause disruptions in care of OSA
treatments for patients in rural areas by imposing new
restrictions. These commenters expressed wishes for a
Stark-like rural exception, based on access to care
arguments.
Response: Though various commenters have compared the
provisions of this rule to the “Stark” rules, this rule is
distinct from Stark and addresses separate concerns.
We acknowledge that rural beneficiaries are more
likely to live at greater distances from sleep facilities.
Thus, these beneficiaries would be more likely to avail
themselves of home sleep testing if it were available.
We also note that the final rule allows an exception
for attended facility-based PSG. Thus, when compared to
Medicare coverage before the March 2008 NCD expansion, the
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