Information for Standalone Home Sleep Apnea Testing Facilities
Medical Services Plan Billing (MSP) and Current Moratorium on standalone Home Sleep Apnea Testing (HSAT) Facility Applications – See announcement here.
Who Can Order a Home Sleep Apnea Test?
Only authorized health professionals are permitted to submit referrals for Level III HSAT studies. Authorized health professionals are limited to:
- Registrants of the College of Physicians and Surgeons of BC (Family and Specialist Physicians)
- Nurse practitioners registered with the BC College of Nurses and Midwives, and
- Naturopathic physicians registered with the College of Naturopathic Physicians of BC
- Note: when an HSAT is ordered by a Naturopath, the test is not covered by the Medical Services Plan. Other restrictions also apply. For more details, see Update to authorized health professionals permitted to submit HSAT referrals (PDF, 289KB)
HSAT Re-Testing
Some extended health providers have, at times, required patients previously diagnosed with Obstructive Sleep Apnea (OSA) to obtain a new positive diagnostic test to be eligible for reimbursement for a replacement sleep disorder breathing device, such as a Continuous Positive Airway Pressure (CPAP) machine.
In June 2022, the Medical Services Commission wrote to all known extended health insurance providers operating in British Columbia and informed them that, as OSA is a chronic condition, any requirement to retest previously diagnosed patients for the purpose of replacement device coverage was contrary to best clinical practices and not insured by the Medical Services Plan (for both retesting and for referrals related to retesting). To see the full text of the Commission’s letter, click here (PDF, 99KB).
Frequently Asked Questions
- What is the Medical Services Plan?
- The Medical Services Plan (MSP) is a health insurance program managed by British Columbia’s Medical Services Commission, on behalf of the provincial government that pays for basic, medically required health services, including diagnostics. Approval to bill MSP for the provision of Diagnostic Services is by application to the Advisory Committee on Diagnostic Facilities, a sub-committee of the Medical Services Commission, which is supported by the Ministry of Health’s Diagnostic Services business unit.
- The Medical Services Plan (MSP) is a health insurance program managed by British Columbia’s Medical Services Commission, on behalf of the provincial government that pays for basic, medically required health services, including diagnostics. Approval to bill MSP for the provision of Diagnostic Services is by application to the Advisory Committee on Diagnostic Facilities, a sub-committee of the Medical Services Commission, which is supported by the Ministry of Health’s Diagnostic Services business unit.
- What is diagnostic facility accreditation?
- Accreditation is a formal, independent verification against established standards to assure the quality of the facility and/or service, and to assist in quality improvement. The Diagnostic Accreditation Program (DAP), a program of the College of Physicians and Surgeons of British Columbia, has a mandate and authority derived from section 5 of the College Bylaws under the Health Professions Act, RSBC 1996, c.183, such that every diagnostic facility must be accredited by the committee before it can render a diagnostic service.
- While the achievement of DAP accreditation is a primary condition to bill MSP for services provided, the Ministry of Health has no role in the accreditation process and accreditation does not automatically translate into approval to bill MSP. For more information on the Diagnostic Accreditation Program click here.
- Can HSAT facilities still apply to bill the Medical Services Plan?
- No, effective January 1, 2022 the Medical Services Commission imposed a five-year moratorium on further applications for new, expanded or relocated standalone home sleep apnea testing facilities.
- No, effective January 1, 2022 the Medical Services Commission imposed a five-year moratorium on further applications for new, expanded or relocated standalone home sleep apnea testing facilities.
- Can non-accredited facilities offer HSAT for free or at a cost to the patient?
- No. Non-accredited diagnostic facilities cannot operate in B.C.
- No. Non-accredited diagnostic facilities cannot operate in B.C.
- Is it possible for an MSP-approved HSAT facility to be purchased? Can a facility’s Certificate of Approval be sold?
- An approved facility can be sold. However, all approvals to bill MSP are site and owner specific, and approval cannot be transferred or assigned. The new owner would need to make a new application for approval to bill MSP and communicate with the DAP to ensure continued accreditation for the purchased company. If sale of an MSP-approved facility is being contemplated, it is recommended the facility operator contact DFadmin@gov.bc.ca for further detail.
- An approved facility can be sold. However, all approvals to bill MSP are site and owner specific, and approval cannot be transferred or assigned. The new owner would need to make a new application for approval to bill MSP and communicate with the DAP to ensure continued accreditation for the purchased company. If sale of an MSP-approved facility is being contemplated, it is recommended the facility operator contact DFadmin@gov.bc.ca for further detail.
- Can a patient be billed for an HSAT if they do not have a B.C. Services Card (i.e., are from outside of the province)?
- Yes, a patient who does not have a valid B.C. Health Care number (e.g., out of province) may be billed for HSAT services. Patients are encouraged to determine if health insurance coverage from their home province is available.
- Yes, a patient who does not have a valid B.C. Health Care number (e.g., out of province) may be billed for HSAT services. Patients are encouraged to determine if health insurance coverage from their home province is available.
- Can a facility move to another location?
- All Certificates of Approval to bill the Medical Services Plan are site and owner specific. There is currently a moratorium on applications for new, expanded and relocated stand-alone HSAT facilities, as such, requests to relocate a Certificate of Approval will generally not be accepted. However, moves of a minor nature may be considered, as well as relocation required due to extenuating circumstances (e.g., eviction, disaster, etc.). Facility operators are encouraged to contact DFAdmin@gov.bc.ca for further direction.
- All Certificates of Approval to bill the Medical Services Plan are site and owner specific. There is currently a moratorium on applications for new, expanded and relocated stand-alone HSAT facilities, as such, requests to relocate a Certificate of Approval will generally not be accepted. However, moves of a minor nature may be considered, as well as relocation required due to extenuating circumstances (e.g., eviction, disaster, etc.). Facility operators are encouraged to contact DFAdmin@gov.bc.ca for further direction.
- Can HSAT done after a patient is on therapy (e.g., to show efficacy of therapy) be billed to MSP?
- Studies that are requisitioned by a physician or nurse practitioner using an appropriately completed and signed requisition form may be billed to MSP.
- Studies that are requisitioned by a physician or nurse practitioner using an appropriately completed and signed requisition form may be billed to MSP.
- Who should MSP billing questions be directed to?
- Facilities approved to bill MSP should direct all billing questions or concerns to Health Insurance B.C. (1-866-456-6950).
- Facilities approved to bill MSP should direct all billing questions or concerns to Health Insurance B.C. (1-866-456-6950).
- How does an MSP-approved facility change its payment number?
- For billing-related issues such as Teleplan, applying for Data Centres and/or new Payment Numbers, contact Health Insurance BC.
- Once an existing facility has its new payment number via HIBC, an Operational Changes Notification Form must be completed/submitted to DFadmin@gov.bc.ca so that the new payment number can be attached to the current facility number. Failure to do so will result in MSP billing claims being rejected.
