20-751 Sleep Testing Can Be Done at Home
Date: 09/24/20
Keep your patients safe in their homes during the COVID-19 pandemic
California Health & Wellness Plan (CHWP) knows members need access to care during the COVID-19 pandemic. Effective immediately as a temporary added benefit, CHWP is permitting medically necessary home sleep tests in lieu of a sleep test at an outpatient facility for CHWP members. This includes those members who may be at risk for untreated sleep apnea.
We understand that some facilities are not conducting sleep studies at this time and some patients may be waiting to be tested for sleep apnea. Refer to provider update 20-616, Sleep Apnea as a Risk Factor for Your Patients, distributed on August 14, 2020, for tools to evaluate and screen patients. You can view provider update 20-616 on the California Health & Wellness website.
Conducting the home sleep test provides safety for your patients at this time. For members with obstructive sleep apnea (OSA) risk factors, getting the test results is crucial to determine care and treatment for these high-risk patients.
Continuation of this extended benefit for a home sleep test will be re-evaluated once the pandemic ends. Facility-based sleep tests require prior authorization as indicated below.
When to submit | Service | Benefit | Prior authorization requirement |
|---|---|---|---|
Immediately | Home sleep test | New | Submit prior authorization request for a home sleep test with the required medical records. |
December 1, 2020 | Facility-based sleep test | Existing | Submit prior authorization request for a facility-based sleep test with required medical records for dates of service starting December 1, 2020. |
View prior authorization requirements online
Prior authorization requirements are available on the California Health & Wellness website and include this new category of sleep studies.
Providers participating through Community Care Independent Practice Association (CCIPA) must follow CCIPA’s prior authorization process.
Additional information
If you have questions regarding the information contained in this update, contact CHWP at 1-877-658-0305.