Rep. Ciscomani Leads Bipartisan Letter Urging CMS to Modernize Sleep Apnea Coverage Standards

WASHINGTON, D.C. - Congressman Juan Ciscomani is spearheading an effort to modernize how the federal government treats people suffering from sleep apnea, a serious medical condition that effects an estimated 30 million Americans.

In a bipartisan letter to the Centers for Medicare and Medicaid Services (CMS), Ciscomani and 17 colleagues are urging the agency to modernize coverage determinations for obstructive sleep apnea diagnosis and treatment to reflect current medical science and standards of care.

The letter, supported by 18 different professional and patient support organizations, highlights growing concerns that outdated criteria are preventing many Americans - particularly women and younger individuals - from receiving accurate diagnoses and timely treatment.

"Updating current criteria in a timely fashion will ensure access to proper diagnosis and treatment options for all people experiencing serious symptoms and health consequences of sleep apnea, including women and younger individuals, to better reflect the real-life variations of how sleep apnea manifests in individuals," the members of Congress wrote.

Sleep apnea is a serious condition that causes breathing to stop and start several times during sleep and can drastically worsen other chronic and acute health conditions. Symptoms include loud snoring, gasping, daytime fatigue, and morning headaches, leading to high blood pressure and heart problems if left untreated.

Ciscomani and his colleagues emphasize that decades of research have demonstrated that obstructive sleep apnea manifests differently across patient populations and that CMS policies have not kept pace with the science. They specifically call on CMS to provide an update on adopting the widely supported H3A hypopnea definition, which medical experts say would improve access to care and health outcomes while reducing long-term health care costs.

Ciscomani underscored the urgency of aligning federal coverage policies with modern medical standards.

"Sleep apnea is a serious public health issue that affects millions of Americans, yet too many patients are falling through the cracks because federal coverage standards are outdated," said Ciscomani. "We have a responsibility to ensure CMS policies reflect current science so patients can access timely, accurate diagnoses and effective treatment - especially women and others whose symptoms have historically been overlooked."

The letter is supported by a broad coalition of 18 national medical, patient advocacy, and research organizations representing clinicians, sleep specialists, and patients across the country, including:

• Alliance of Sleep Apnea Partners
• American Academy of Cardiovascular Sleep Medicine
• American Academy of Dental Sleep Medicine
• American Academy of Sleep Medicine
• American Association for Respiratory Care
• American Association of Sleep Technologists
• American College of Chest Physicians
• American Heart Association
• American Thoracic Society
• Circadian Sleep Disorders Network
• Hypersomnia Foundation
• Narcolepsy Network
• National Sleep Foundation
• Project Sleep
• Restless Legs Syndrome Foundation
• Sleep Consortium
• Sleep Research Society
• Wake Up Narcolepsy

Julie Flygare, JD, President and CEO of Project Sleep, praised Rep. Ciscomani's leadership on the issue:

"This is such an important issue to ensure people - especially women - receive accurate sleep apnea diagnosis and treatment," said Flygare. "We are grateful to Congressman Ciscomani for leading this critical effort to modernize coverage standards and help more Americans get the restorative sleep they need to live healthy, productive lives."

The bipartisan letter was led by Congressman Juan Ciscomani (R-AZ-06) and signed by Representatives Sanford D. Bishop, Jr. (D-GA-02), Tim Burchett (R-TN-02), Salud Carbajal (D-CA-24), Donald G. Davis (D-NC-01), Suzan K. DelBene (D-WA-01), Laura Friedman (D-CA-30), Josh Gottheimer (D-NJ-05), Zoe Lofgren (D-CA-18), Stephen F. Lynch (D-MA-08), Lucy McBath (D-GA-06), Rich McCormick, MD, MBA (R-GA-07), Kristen McDonald Rivet (D-MI-08), Joe Neguse (D-CO-02), Eleanor Holmes Norton (D-DC-AL), Chris Pappas (D-NH-01), John H. Rutherford (R-FL-05), James R. Walkinshaw (D-VA-11), and Stephen F. Lynch (D-MA-08).

The lawmakers requested a timely response from CMS outlining the agency's perspective on modernizing OSA coverage criteria and any upcoming activities or timelines related to updating standards of care.

Read the final letter HERE.