Executive Summary: Optimal Noninvasive Ventilation Medicare Access Promotion (ONMAP)

Abstract The current national coverage determinations (NCDs) for noninvasive ventilation for patients with thoracic restrictive disorders (TRD), chronic obstructive pulmonary disease (COPD) and hypoventilation syndromes (HS) 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 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 obstructive sleep apnea (OSA) and central sleep apnea (CSA), 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 multi-society (American Thoracic Society, American Academy of Sleep Medicine, 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 Disease, COPD, Hypoventilation, OSA, CSA). The expert panel met during a two day virtual summit in October 2020, and subsequently crafted written documents designed to achieve provision of “the right device at the right time to the right patient.” These documents have been endorsed by the participating societies after peer-review and publication in CHEST and will be used to inform efforts to revise the current NCDs.