The Health Law Sidebar
April 8, 2020

Attention Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Providers: Medicaid Policy Changes

As a result of the coronavirus (COVID-19) outbreak, the New York State  Department of Health (NYSDOH) has issued new guidance to Medicaid Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) providers. The guidance applies to Medicaid covered services as described below when delivered by Medicaid-enrolled DMEPOS providers. This guidance is effective immediately and shall remain in effect for the remainder of the disaster emergency declared by Governor Cuomo’s Executive Order No. 202 or until the issuance of subsequent guidance by the NYSDOH prior to the expiration of the Executive Order.

Delivery Guidelines-Proof of Delivery (DMEPOS Policy Manual, p.19).

This guidance waives in-person signatures of members or caregivers for Durable Medical Equipment, Prosthetics, Orthotics and Supplies delivered to the members home. The DMEPOS provider must maintain adequate information to track the delivery and may communicate to the member that the delivery was made by text, email or telephone voice message. The method used should be documented in the delivery record and retrievable for future audit. All other delivery requirements remain in effect.

Topical Hyperbaric Oxygen Chamber (TOWT) and Negative Wound Pressure Wound Therapy (NWPT) (DMEPOS Procedure Guidance, pp.99–104).

During the state of emergency, weekly wound measurement reporting is not required for authorization. The physician ordering and monitoring the TOWT and/or NWPT therapies may use telehealth to assess the monitoring status of the wound and the effectiveness of treatment. The ordering physician will establish a clinical plan for appropriate monitoring (e.g. weekly, biweekly, but no less than monthly). The documentation of the telehealth visit must be submitted to the Department for prior approval, to show the efficacy of the treatment.

Medical/Surgical Supplies Prior Approval Renewals (DMEPOS Policy Manual, p.6)

Members who are currently receiving medical/surgical supplies under prior approval will be renewed at current levels, with the submission of a physician fiscal order. All other documentation requirements are waived at this time. Requests for new medical/surgical supplies still require documentation to show medical necessity of the request.

Medical Supplies Limits Raised for Suction and Nebulizers (DMEPOS Procedure Guidelines, pp.18–20)

The following codes used for suction and nebulizers will have monthly maximum limits raised when medical necessary for the treatment of COVID-19:

•A4605: Tracheal suction catheter, closed system, each. Limit raised to 30

•A4624 Tracheal suction catheter, any type, other than closed system, each (tray). Limit raised to 300

•A4628 Oropharyngeal suction catheter, each (Yankauer). Limit raised to 30

•A7003 Administration kit, with small volume nonfiltered pneumatic nebulizer, disposable. Limit raised to 10

•A7004 Small volume nonfiltered pneumatic nebulizer Limit raised to 10. •A7005 Administration set, with small volume nonfiltered pneumatic nebulizer. Limit raised to 10

•A7007 Large volume nebulizer. Limit raised to 10

•A7015 Aerosol mask, use with DME nebulizer. Limit raised to 10

•S8100 Holding chamber or spacer or use with an inhaler or nebulizer. Limit raised to 8

•S8101 Holding changer or spacer for use with an inhaler or nebulizer; with mask. Limit raised to 8

ADDITIONAL INFORMATION

Current guidance on telehealth can be found at: https://www.health.ny.gov/health_care/medicaid/program/update/2020/index.htm.

The current DMEPOS Policy Guidelines can be found at: https://www.emedny.org/ProviderManuals/DME/PDFS/DME_Policy_Section.pdf.

The current DMEPOS Procedure Codes and Coverage Guidelines can be found at:

https://www.emedny.org/ProviderManuals/DME/PDFS/DME_Procedure_Codes.pdf

QUESTIONS

If you have questions on this guidance, please call 1-800-342-3005 or email OHIPMEDPA@health.ny.gov.

Any Medicaid Managed Care questions regarding policy should be directed to the member’s Medicaid Managed Care plan.

If you wish to speak to a private attorney please contact David R. Ross, Senior Shareholder, at (518) 312-0167 or via e-mail at dross@oalaw.com.