Payer Policy Review Committee Member

Committee Member
Service as a committee member is a one-year appointment with potential for reappointment for up to two additional terms. Service requires participation on monthly conference calls and collaborative involvement on projects that meet the committee mandate. 

Mandate: The Payer Policy Review Committee develops and maintains resources based on AASM publications for payers to use when updating or establishing sleep-specific policies.

Current Goals for 2021/2022:

1. Communicate with payers to encourage correct interpretation and adoption of AASM recommendations.
2. Create and maintain public online scorecards to show committee assessments of which payers policies align with the Adult Diagnostic Testing for OSA Clinical Practice Guideline.
3. Develop a payer scorecard for the treatment of insomnia (pharmacologic, behavioral, and psychological).
4. Review private payer policy alignment with the AASM Recommended hypopnea scoring criteria, encourage adoption of Recommended scoring criteria and communicate to members whether private payer policies allow using the Recommended scoring criteria.
5. Review and comment on payor policies for medications for patients with hypersomnia.
6. Draft a template letter for members and patients to use when advocating for alignment of the payer policy with the AASM Recommended hypopnea scoring criteria.
7. Review private payer policies to see if they require accreditation for sleep facilities and advocate for the inclusion of this requirement in order to ensure high quality patient care.
8. In collaboration with the Coding & Compliance Committee, review the PAP national coverage determination (240.4) and local coverage determination (L33718) to identify any issues that impede patient care or are inconsistent with current AASM guidance and provide a rationale for why the current criteria and/or language are problematic.
9. Track and review member concerns specific to payer policy issues and respond, as necessary.