Executive Summary

Abstract

The current national coverage determinations (NCDs) for noninvasive ventilation for patients with thoracic restrictive disorders, COPD, and hypoventilation syndromes were formulated in 1998. New original research, updated formal practice guidelines, and current consensus expert opinion have accrued that are in conflict with the existing NCDs. Some inconsistencies in the NCDs have been noted, and the diagnostic and therapeutic technology has also advanced in the last quarter century. Thus, these and related NCDs relevant to bilevel positive airway pressure for the treatment of OSA and central sleep apnea need to be updated to ensure the optimal health of patients with these disorders. To that end, the American College of Chest Physicians organized a multisociety (American Thoracic Society, American Academy of Sleep Medicine, and American Association for Respiratory Care) effort to engage experts in the field to: (1) identify current barriers to optimal care; (2) highlight compelling scientific evidence that would justify changes from current policies incorporating best evidence and practice; and (3) propose suggestions that would form the basis for a revised NCD in each of these 5 areas (thoracic restrictive disorders, COPD, hypoventilation syndromes, OSA, and central sleep apnea). The expert panel met during a 2-day virtual summit in October 2020 and subsequently crafted written documents designed to achieve provision of "the right device to the right patient at the right time." These documents have been endorsed by the participating societies following peer review and publication in CHEST and will be used to inform efforts to revise the current NCDs.

An overview of noninvasive ventilation in cystic fibrosis

“…Reimbursement criteria are variable throughout the country. 61 The ONMAP Technical Expert Panel (Optimal Noninvasive Ventilation Medicare Access Promotion) recommendations for national coverage determination of NIV are less stringent in that no nocturnal hypoxemia is requisite, and greater clarity is provided for when more advanced home ventilation is needed over BPAP-S. 61 Patients newly initiated on NIV need to be evaluated on or after Day 61 of therapy to document that the patient reports benefit with use, and that there is use of device for at least 4 h per 24-h period. 66 Table 1 describes common modes of NIV, and Table 2 summarizes studies that observed use of home NIV in adult and pediatric CF patients, modes and settings utilized.…”

“…No CMS guidelines are currently present for guidance in obtaining more advanced devices. Reimbursement criteria are variable throughout the country 61 . The ONMAP Technical Expert Panel (Optimal Noninvasive Ventilation Medicare Access Promotion) recommendations for national coverage determination of NIV are less stringent in that no nocturnal hypoxemia is requisite, and greater clarity is provided for when more advanced home ventilation is needed over BPAP‐S 61 .…”