Non-Invasive Ventilation – Positive Airway Pressure

Last updated:

RAP Schedule no.

AY01, AY14, AY17, AY19, AY22, AY23, AY24, AY25, AY28, AY29, AY30 and AY31 [refer to RAP Schedule]

Definition

Non-Invasive Ventilation – Positive Airway Pressure

Sleep related breathing disorders (SRBD) are a spectrum of disorders where impaired breathing during sleep impacts on daytime functioning. 

There are three types of Non-Invasive Ventilation – Positive Airway Pressure (PAP) machines:

  • Fixed level;
  • Bi-Level; and
  • Auto Titrating. 

The patient interface is most commonly via a nasal mask, covering the nose only, but full-face masks, covering the mouth and nose, and other accessories are available depending on the entitled person’s clinical need.

Humidification

PAP machines include a humidification function.

A separate humidifier under RAP Item AY03 should not be prescribed or supplied except for entitled persons:

  • receiving Domiciliary Medical Oxygen Therapy (DMOT); or
  • with a tracheostomy or laryngectomy.

Refer to the RAP National Guidelines for Domiciliary Medical Oxygen Therapy for AY03 prescribing and supplying information.

Eligibility

The  entitled person must have a clinical need and a Department of Veterans’ Affairs (DVA):

  • Gold Card; or
  • White Card with an accepted condition relating to the clinical need for the equipment.

Prescribing

Assessing health provider

PAP machines must be prescribed by a suitably qualified assessing health provider as specified below:

AY01: Non-Invasive Ventilation (PAP) – Fixed Level;
AY14: Non-Invasive Ventilation (PAP) – Bi-Level;
AY22: Non-Invasive Ventilation (PAP) – Device Trial;
AY23: Non-Invasive Ventilation (PAP) – Auto Titrating;
AY24: Non-Invasive Ventilation (PAP) – Recycled;
AY28: Non-Invasive Ventilation (PAP) – Travel Continuous Positive Airway Pressure (CPAP) – Short Term Rental; and
AY31: Non-Invasive Ventilation (PAP) – Non-Contracted Item (Exceptional Circumstances)

  • Respiratory Clinic (RC);
  • Respiratory Physician (S); or 
  • Ear, Nose and Throat Specialist (S).

AY19: Non-Invasive Ventilation (PAP) – Consumables and Accessories

  • Respiratory Clinic (RC);
  • Respiratory Physician (S);
  • Ear, Nose and Throat Specialist (S);
  • General Practitioner (GP);
  • Respiratory Clinic (RC);
  • Registered Nurse (RN); or
  • Physiotherapist (Physio).

AY30: Non-Invasive Ventilation (PAP) – Education or Follow Up

  • This item is for the contracted supplier to provide education and training to the entitled person, covering the correct set up and safe use of the prescribed PAP and other respiratory aids and appliances, including consumables and accessories.

Prior Approval

Prior approval is not required for the supply of PAP as long as all eligibility criteria and prior approval limits are met and contracted PAP items are prescribed.

Prior approval is required for:

  • White Card holders;
  • PAP items that exceeds the financial or quantity limits set in the RAP Schedule;
  • clients who live in residential aged care; and
  • the supply of non-contracted PAP items under RAP Item AY31. DVA will only consider this in exceptional circumstances when an entitled person’s clinical need cannot be met by contracted PAP items. The assessing health provider must explain the clinical reasons for the supply of non-contracted PAP items in the D9140 Application for Positive Airway Pressure (PAP) Equipment form

Deciding on the most appropriate item

An assessment needs to be completed by a suitably qualified assessing health provider to determine the clinical need and the most suitable treatment.

A Polysomnographic Sleep Study to confirm the presence of a SRBD must be conducted before prescribing a PAP machine.

Entitled persons with no previous history of a PAP machine from RAP

Entitled persons prescribed a PAP machine will complete a mandatory trial for up to 30 days. The trial will ensure the PAP therapy is tolerated by the entitled person before a PAP machine is supplied. The entitled person can test several types of PAP machines, including masks, to find the most suitable machine to address the entitled person’s clinical need and treatment regime. Up to three 30-day trial periods can be conducted if required.

Entitled persons with a PAP machine from RAP

Entitled persons already using a PAP machine from RAP may experience a change of clinical status requiring an adjustment to their treatment regime.

Device Trial

If an upgrade or a new PAP machine is required, this must be prescribed by the assessing health provider.

The contracted supplier may complete a trial with the entitled person for up to 30 days and test several types of PAP machines, including masks, to find the most suitable machine. Up to three 30-day trial periods may be conducted if required.

If an upgrade or a new PAP machine is prescribed within five years of supplying a PAP machine, this will be referred to DVA for prior approval before trialling or supplying a new machine.  

Mask Trial

If an alternative mask is required e.g. after an operation or facial changes because of weight loss/gain, this may be prescribed by the assessing health provider or initiated by the entitled person directly to the contracted supplier.

The contracted supplier may trial up to three different masks with the entitled person. The trial should be resolved within a one month period.

If a different mask is requested within three months of supplying a mask, a prescription from the assessing health provider is required and will be referred to DVA for prior approval before trialling or supplying a different mask.

Travel Continuous Positive Airway Pressure (CPAP)

Generally one PAP machine will meet the entitled person’s clinical needs both at home and while travelling.

For entitled persons using a PAP machine from RAP that is not a travel or mini CPAP machine, the assessing health provider can prescribe a short term rental of a travel CPAP for up to three months while the entitled person is travelling away from home.  The travel CPAP is smaller and lighter and will enable continuation of the entitled person’s treatment regime.

Request for Treatment

For a Gold Card holder

  1. An assessment must be conducted by a suitably qualified assessing health provider to determine the clinical need and the most suitable treatment.
  2. The assessing health provider should complete the D9140 Application for Positive Airway Pressure (PAP) Equipment form and forward it to one of the contracted suppliers detailed on the last page of the form.
  3. The contracted supplier will seek prior approval if required from DVA.

For a White Card holder

  1. An assessment must be conducted by a suitably qualified assessing health provider to determine the clinical need and the most suitable treatment.
  2. Ring DVA on 1800 550 457 or email rapgeneralenquiries [at] dva.gov.au to check eligibility under the entitled person’s accepted disability(ies).
  3. If the entitled person is eligible, the assessing health provider should complete the D9140 Application for Positive Airway Pressure (PAP) Equipment form and ensure the entitled person’s medical condition for which the therapy is required is on the form. Forward the form to one of the contracted suppliers detailed on the last page of the form.
  4. The contracted supplier will seek prior approval if required from DVA.

For entitled persons in rural or remote areas

A treating Specialist or Respiratory Clinic may request a GP to provide local clinical management of their client who lives in a rural and remote area. The GP can prescribe for these clients under the authority of the treating Specialist or Respiratory Clinic. The GP’s name and address are to be provided together with details of the treating Specialist or Respiratory Clinic on the D9140 Application for Positive Airway Pressure (PAP) Equipment form.

Reviewing the Prescription

The assessing health provider should regularly review the entitled person’s PAP machine needs to ensure the PAP therapy is still suitable for the entitled person’s medical condition.

If a change of prescription is required, the assessing health provider can complete a new prescription.

To assist with reviewing the prescription, the contracted supplier will provide to the assessing health provider data reports on the entitled person’s use of the PAP machine. This will happen when:

  • the entitled person is trialling PAP machines.
  • the entitled person has been supplied a PAP machine and is not showing compliance over a 30 day period.
  • the assessing health provider requests it.

Ceasing PAP

Where the removal of PAP equipment is requested by an entitled person, the equipment should not be removed without discussion occurring with the assessing health provider.  It is the responsibility of assessing health provider to notify the contracted supplier if the PAP equipment is no longer clinically required. The contracted supplier will arrange to collect the DVA funded equipment.

On the death of a entitled person, it is the responsibility of the entitled person’s next of kin to notify the contracted supplier to cease the supply.

Additional information

Consumables and Accessories

RAP Item AY19 can be prescribed by the assessing health provider at the time of prescribing a PAP machine using D9140 Application for Positive Airway Pressure (PAP) Equipment form.

After a PAP machine has been supplied by RAP, requests for consumables and accessories, including replacement consumables and accessories, can only be prescribed by the assessing health provider or initiated by the entitled person directly to the contracted supplier.

Consumables and accessories should be provided by the contracted supplier who supplied the PAP machine where possible. Requests for consumables and accessories from a different contracted supplier will require a copy of the original prescription before supplying.

Consumables (e.g. filters and hoses) should be replaced at a minimum of every 12 months or when clinically required. Masks should be replaced every six to 12 months or when clinically required. Other consumables or accessories should be replaced when required.

If the entitled person has purchased the PAP machine privately and requires access to consumables and accessories, a new request should be submitted on a D9140 Application for Positive Airway Pressure (PAP) Equipment form.

Ultra Violet (UV) sanitisers

DVA does not fund UV sanitisers for use in PAP machines as this may void the warranty of the device and is not recommended by manufacturers.

Battery back-up

A deep cycle battery may be supplied when the entitled person is at risk from temporary failure of their PAP machine as a result of: 

  • verifiable, frequent power failures, e.g. twice weekly interruptions to power supply; or
  • no mains power (240v) available to operate the PAP machine, e.g. camping, sailing.

Entitled persons who live off-grid using solar energy with no local access to mains power may require an alternative battery if their solar panel battery bank is not enough to power a PAP machine. This is a non-contracted item and will be referred to DVA for prior approval under RAP Item AY31.

Generators

RAP does not supply generators. A deep cycle battery is sufficient to maintain power to a PAP machine and can be recharged through a motor vehicle.

Specialised pillows

RAP does not provide clients with household items. General off the shelf pillows and bedding are considered household items.  Only specialised PAP pillows to accommodate tubing e.g. a side sleeper, may be considered where there is clinical justification from the respiratory clinic or a physiotherapist with relevant experience. Evidence should be provided that alternative options have been trialled.

Contracted suppliers

Contracted suppliers are listed on the D9140 Application for Positive Airway Pressure (PAP) Equipment form and on the DVA website. Contracted suppliers provide all PAP items covered by this Guideline.

Contracted PAP items must not be sourced from a non-contracted supplier.

Contracted suppliers will:

  • provide the prescribed PAP items;
  • complete PAP machine trials and/or mask trials, when required, and advise the outcomes of those trials:
    • When a PAP machine and/or mask was found suitable – the type of PAP machine and/or mask supplied to the entitled person for continued use; or
    • When no PAP machine and/or mask was found suitable – the types of PAP machines and/or masks trialled, data reports and any other information for the assessing health provider to complete a review of the prescription with the entitled person.
  • provide education and follow-up training to the entitled person and/or carer on the correct set up and safe use of PAP and other respiratory aids and appliances, including consumables and accessories;
  • refer clinical and compliance concerns to the assessing health provider to complete a review of the entitled person’s prescription; and
  • provide data reports to the assessing health provider to assist with reviewing the entitled person’s prescription.

National Disability Insurance Scheme (NDIS)

PAP can be provided by either DVA’s Rehabilitation Appliances Program or the NDIS through an individual care plan.

Essential Medical Equipment Payment (EMEP)

The entitled person with PAP equipment may be eligible for the EMEP to assist with the costs of running this essential medical equipment. The assessing health provider may like to discuss this payment with the entitled person. To find out more and for the relevant claim forms, visit DVA EMEP website.

Australian Standards and legislative requirements

All PAP machines provided by DVA under contracted arrangements are listed with the Therapeutic Goods Administration.

Health Provider Hotline

1800 550 457

Health Providers can contact DVA for any enquiries by calling the Provider Hotline: (Please press Option 1 when prompted for RAP).

 

 

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