COVID-19 Guidance for Medicaid Providers

Guidance on Medicaid Changes to Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Policy

  • Guidance is also available in Portable Document Format (PDF)

March 28, 2020

Re: Medicaid Changes to Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Policy

Dear Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Providers: The New York State Department of Health (NYSDOH) is providing this guidance to Medicaid Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) providers pertaining to the current novel coronavirus (COVID–19) outbreak. The guidance applies to Medicaid covered services, as described below when delivered by enrolled DMEPOS providers. This guidance is effective immediately, and shall remain in effect for the remainder of the disaster emergency declared by Executive Order No. 202, or until the issuance of subsequent guidance by the NYSDOH prior to the expiration of such state disaster emergency declaration.

BACKGROUND

The health and safety of the State´s health care workforce and our ability to provide and support patient care remain our top priorities. Recently, community–wide transmission of COVID–19 has occurred in the United States (US), and the number of both Persons Under Investigation (PUIs) and confirmed cases is increasing. The situation with COVID–19 infections identified in the US continues to evolve and is rapidly changing. It is important to keep apprised of current guidance by regularly visiting the Centers for Disease Control and Prevention (CDC) and NYSDOH websites, as well as the NYSDOH Health Commerce System (HCS), for the most up–to–date information for healthcare providers. Those websites are available at:

It is important to keep staff, enrollees, and consumers updated as the situation changes, and to educate them about the disease, its signs and symptoms, and necessary infection control measures to protect themselves and the people they serve. NYSDOH distributes alerts and advisories on its website. It is vital that all organizations maintain up–to–date contact with both NYSDOH and the CDC.

POLICY CHANGES

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: /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.

Your diligence in implementing appropriate measures for COVID–19 preparedness is appreciated.