Vague laws create trouble for J&L

Rules regarding who can perform CPAP set ups and other respiratory care vary by state, but as a recent court case showed, interpretations can also differ.

In January, Middlebury, Conn.-based J&L Medical, a respiratory provider, agreed to pay $600,000 to settle allegations that it violated state and federal regulations by using unlicensed technicians to set up CPAP and Bi-level machines. The provider said using technicians, such as RT students or licensed practical nurses supervised by a licensed RT is common practice and that the company had a different interpretation of state law than the
government.

“This was a matter of our disagreeing with their interpretation of Connecticut law about who can work with sleep apnea patients to do the initial set up of their CPAP machines,” company President and Co-owner John Loyer said in a statement. “We think it's important for our patients and the members of the medical community to understand that the government never claimed J&L Medical Services failed to deliver quality care or equipment.”

Respiratory care is overseen in each state by a board that regulates respiratory care, licensure and other requirements. In North Carolina, for example, there's no requirement that a respiratory therapist must do the fittings, so long as there is a certified supervisor. 

“As far as PAP is concerned, if it's under the supervision of a therapist, the actual hands-on (aspect) has been relegated in certain areas to technicians,” said George Kucka, president and CEO of Fairmeadows Home Health Care and chair of AAHomecare's HME/Respiratory Therapy Council. “That's not unusual, but whether it's legal or not depends on the state.”

Everyone wants to provide quality patient care, but it's often a matter of economics how they go about it, says one provider.

“With decreasing reimbursement, we can't afford respiratory care practitioners or registered nurses to do our fittings,” the provider said.