20-788 Sleep Testing Can Be Done at Home
Date: 10/08/20
This information applies to Physicians, Participating Physician Groups (PPGs), Hospitals, and Ancillary providers.
For Medi-Cal, this information applies to Kern, Los Angeles, Riverside, Sacramento, San Bernardino, San Diego, San Joaquin, Stanislaus, and Tulare counties.
Keep your patients safe in their homes during the COVID-19 pandemic
Health Net knows members need access to care during the COVID-19 pandemic. Effective immediately as a temporary added benefit, Health Net is permitting medically necessary home sleep tests in lieu of facility-based sleep tests for Medi-Cal fee-for-service members. This includes those members who may be at risk for untreated sleep apnea.
Tools to evaluate and screen patients
We understand that some facilities are not conducting sleep studies at this time and some patients may be waiting for a sleep test for sleep apnea. Refer to provider update 20-613, 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 20-613 online in the Provider Library, then select Medi-Cal > Updates and Letters.
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 15, 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 15, 2020. |
View prior authorization requirements online
Log in to the Health Net Provider Portal. Select Transactions > Authorizations, and select Services Requiring Prior Authorization under Next Steps.
If you have questions regarding the information contained in this update, contact the Health Net Medi-Cal Provider Services Center within 60 days at 1-800-675-6110.