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Section A - Policy

16. Specific Programs & Technical Details

Appendix 9-Continuous Positive Airways Pressure Program

There has been increasing support from both consumers and physicians for the provision of assistance to consumers with severe obstructive sleep apnoea. There is also reliable medical evidence that CPAP services are an effective response to severe obstructive sleep apnoea. The NH&MRC in their July 1993 report, Treatment of Obstructive Sleep Apnoea, identified the ready availability of CPAP devices to patients with obstructive sleep apnoea syndrome as desirable and cite advice supporting these conclusions from the Australian Health Technology Advisory Committee (AHTAC).

The CPAP Pilot Program was introduced on 1 July, 1997 and has now been effectively operating for two years. Feedback from health care providers indicates that the provision of CPAP services through this Program has been beneficial to the management of severe obstructive sleep apnoea and that access to services has improved health outcomes and quality of life for consumers and reduced health care costs.

2. Program Objectives

The objectives of the CPAP Program are to:

• Provide accessible, high quality and cost effective CPAP services; and
• Encourage improvement in the provision of CPAP services.

3. Consumer Eligibility

Consumers eligible for CPAP services through this program must:

• Be managed by a hospital participating in the Program and assessed by an accredited sleep laboratory;
• Have 20 apnoeas/hypopnoeas per hour and/or 15 apnoeas/hypopnoeas per hour with underlying cardiovascular, neurological or pulmonary disease;
• Be health care card or equivalent concessional card holders or otherwise demonstrate financial disadvantage;
• Comply with CPAP usage requirements; and
• Consent to consumer level data being forwarded to the Department of Human Services for the purposes of review and evaluation.

4. Provider Arrangements

Hospitals participating in the CPAP Program are responsible for:

• Coordinating consumer assessment through sleep disorder centres;
• Prescribing CPAP services and authorising a supplier to provide CPAP services;
• Ensuring follow up and compliance through supplier(s) of CPAP services;
• Undertaking clinical reviews at one and three months and then annually including sleep studies where necessary; and
• Reporting and accountability.

5. CPAP Supply Arrangements

The Department no longer considers it necessary to have an approved supplier arrangement for the CPAP Program, as in the previous two years. The approved supplier process was originally employed for the pilot phase of the Program to ensure high quality competitive service provision and pricing, and to foster development of the market place. The Department considers that this has been achieved.

Health Care Networks/hospitals participating in the program are required to make individual arrangements for the purchase of CPAP devices and associated services in accordance with the purchasing principles normally employed by the Department. Subject to the equipment meeting TGA requirements, Sleep Centres can determine the equipment they prescribe for patients.

Eligible clients are entitled to one CPAP device and are required to make a 10% co-payment for the cost of CPAP devices. Consumables associated with CPAP devices are to be purchased by consumers.

CPAP devices are purchased with funds allocated by the Program and owned by the prescribing hospital and on permanent loan to consumers. Should it become evident that CPAP devices are no longer being used by consumers, they should be recalled and reissued to another consumer through the supplier.

6. Budgets and Funding Arrangements

In preparation for mainstreaming the program, funding for CPAP in 1999-2000 will be provided as a specified grant to participating hospitals. Budgets may be adjusted following receipt of final Income and Expenditure Reports for 1998-99 due by 30 July 1999. Unlike previous years, budgets will not be reviewed on a quarterly basis, but will be reviewed at the end of the financial year and will assist in the determination of the following years funding allocation.

Hospitals are responsible for managing the funds allocated, although arrangements may be made with suppliers for the collection of co-payments on their behalf.

CPAP devices which are recalled should be reissued to consumers eligible under the Program. The cost of servicing and repairs for the reissue of CPAP devices should be charged to the Program.

The funds are allocated specifically for the purchase of CPAP devices and associated services. The cost of masks and other consumables are the responsibility of consumers.

Hospitals will provide services within the funds allocated. Unexpended funds will be recalled by the Department as part of the financial year wrap-up for the Program.

7. Reporting Requirements

Participating hospitals are required to:

• Provide an income and expenditure acquittal relating to the Program for the 1999/00 financial year by 31 July 2000. This statement must include certification by the Chief Executive Officer that funds received have been expended in accordance with these Guidelines; and
• Provide other information as required.

8. Service Development

The Department has funded a Sleep Disorders Consortium involving most of the major Victorian sleep laboratories to examine the performance, cost-effectiveness and quality of life outcomes of the provision of services through the CPAP Program. This program is due to be completed by 31 January, 2000. The study also aims to develop a minimum dataset to form the basis of clinical practice guidelines for the management of obstructive sleep apnoea.

9. Contact Persons

Vivien Adler, Manager Continuity, Acute Health
Tel: (03) 9616 7100 Fax: (03) 9616 8347 e-mail: vivien.adler@dhs.vic.gov.au

Lisa Basford, Project Officer, Continuity, Acute Health
Tel: (03) 9616 9804 Fax: (03) 9616 8347 e-mail: lisa.basford@dhs.vic.gov.au

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