Medicare Advantage

​Waiver of certain requirements during COVID-19 outbreak related to Durable Medical Equipment (DME), prosthetics, orthotics, and supplies for Medicare Advantage members (Updated March 24, 2021)


Policies Impacted

MA00.002g​ Continuous Glucose Monitors and Artificial Pancreas Device Systems (APDS)

MA00.010ad PPO Network Rules for Provision of Specialty Services for Durable Medical Equipment and Laboratory, Radiology, and Physical Medicine and Rehabilitative Servic​es​​

MA05.001e​ High-Frequency Chest Wall Oscillation Devices​

MA05.002d​ Hospital Beds and Accessories​

MA05.003d Speech and Non-Speech Generating Devices

MA05.004d Pneumatic Compression Therapy Devices

MA05.005d Automatic External Cardioverter Defibrillators (Wearable and Nonwearable)

MA05.006e Transc​utaneous Electrical Stimulators (TENS) and Associated Supplies​

MA05.007d Nebulizers and​ Inhalation Solutions

MA05.008b Negative Pressure Wound Therapy (NPWT) Systems

MA05.009a Cervical Traction Devices for In-home Use​

MA05.010f​  Ankle-Foot/​Knee-Ankle-Foot Orthoses

MA05.011b Seat Lift M​echanisms​

MA05.012a Orthopedic Foo​twear

MA05.013d​ Knee Orthoses​

MA05.017c Home Oxygen Therapy

MA05.018b Osteogenic Stimulators (ie, Electrical Bone Growth Stimulation and Low-​Intensity Ultrasound Accelerated Fracture Healing System)​

MA05.023a Whe​elchair ​Cush​ions and Seating​​

MA05.024c Lower Limb Prostheses

MA05.025d​ Pressure-Reducing Support Surfaces​

MA05.026b​ Manual Wheelchairs​

MA05.030c Spinal Orthoses

MA05.031b​ Patient Lifts​

MA05.032a​ Power Wheelchairs (PWCs), Power-Operated Vehicles (POVs), and Push-Rim Activated Power-Assist Devices​

MA05.033b External Breast Prostheses

MA05.044j​ Durabl​e Med​ical Equipment (DME)​​​

MA05.046f​ Wheelchair Options and Accessories​

MA05.047e Treatment of Obstructive Sleep Apnea (OSA) and Primary Snoring for Adults

MA05.053g Implantable and External Infusion Pumps

MA05.054g Urolo​gic​al Supplies​​

MA05.058a Neuromuscular Electrical Stimulators (NMES) and Functional Electrical Stimulators (FES)

MA07.058i Sleep Disorder Testing and Positive Airway Pressure Therapy Services and Supplies



Purpose

The purpose of this News Article is to provide advance notice regarding the temporary waiver of certain requirements for Durable Medical Equipment (DME), as well as prosthetics, orthotics, and supplies in response to Coronavirus Disease 2019 (COVID-19).

This communication addressing DME, prosthetics, orthotics, and supplies is effective for the duration of the Federal Public Health Emergency.​



Background

There is currently an outbreak of respiratory disease caused by a novel coronavirus, which has now been detected both nationally and internationally. The virus has been named “SARS-CoV-2” and the disease it causes has been named “Coronavirus Disease 2019” (COVID-19). The SARS-CoV-2 virus has demonstrated the capability to rapidly spread, leading to significant impacts on healthcare systems and causing societal disruption. The potential public health threat posed by COVID-19 is high globally. To effectively respond to the COVID-19 outbreak, rapid detection of cases and contacts, appropriate clinical management and infection control, and implementation of community mitigation efforts are critical.

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Indications

N/A



Coverage Statement


During this COVID-19 outbreak, the Company is waiving signature and proof of delivery requirements for Durable Medical Equipment (DME) when a signature cannot be obtained because of the inability to collect signatures. Suppliers should document in the medical record the appropriate date of delivery and that a signature was not able to be obtained because of COVID-19.

During the COVID-19 outbreak, certain DME, as well as prosthetics, orthotics, and supply replacement requirements (i.e. face-to-face requirement, a new professional provider order, and a new medical necessity documentation) may be waived when an item is lost, destroyed, irreparably damaged, or otherwise rendered unusable. Suppliers must still include a narrative description on the claim explaining the reason why the equipment must be replaced and are reminded to maintain documentation indicating that the DME, prosthetics, orthotics, and supplies were lost, destroyed, irreparably damaged or otherwise rendered unusable or unavailable as a result of the emergency.

"Durable Medical Equipment (DME), prosthetics, orthotics, and supplies" are addressed in the current versions of the following policy bulletins:


Policy NumberPolicy Title
MA00.002Continuous Glucose Monitors and Artificial Pancreas Device Systems (APDS)
MA00.010PPO Network Rules for Provision of Specialty Services for Durable Medical Equipment and Laboratory, Radiology, and Physical Medicine and Rehabilitative Services
MA05.001High-Frequency Chest Wall Oscillation Devices
MA05.002Hospital Beds and Accessories
MA05.003Speech and Non-Speech Generating Devices
MA05.004Pneumatic Compression Therapy Devices
MA05.005Automatic External Cardioverter Defibrillators (Wearable and Nonwearable)
MA05.006Transcutaneous Electrical Stimulators (TENS) and Associated Supplies
MA05.007Nebulizers and Inhalation Solutions
MA05.008Negative Pressure Wound Therapy (NPWT) Systems
MA05.009Cervical Traction Devices for In-Home Use
MA05.010Ankle-Foot/Knee-Ankle-Foot Orthoses
MA05.011Seat Lift Mechanisms
MA05.012Orthopedic Footwear
MA05.013Knee Orthoses
MA05.017Home Oxygen Therapy
MA05.018Osteogenic Stimulators (ie, Electrical Bone Growth Stimulation and Low-Intensity Ultrasound Accelerated Fracture Healing System)
MA05.023Wheelchair Cushions and Seating
MA05.024Lower Limb Prostheses
MA05.025Pressure Reducing Support Surfaces
MA05.026Manual Wheelchairs
MA05.030Spinal Orthoses
MA05.031Patient Lifts
MA05.032Power Mobility Devices, Power-Operated Vehicles (POVs), and Push-Rim Activated Power-Assist Device
MA05.033External Breast Prostheses
MA05.044Durable Medical Equipment (DME)
MA05.046Wheelchair Options and Accessories
MA05.047Treatment of Obstructive Sleep Apnea (OSA) and Primary Snoring for Adults
MA05.053Implantable and External Infusion Pumps
MA05.054Urological Supplies
MA05.058Neuromuscular Electrical Stimulators (NMES) and Functional Electrical Stimulators (FES)
MA07.058Sleep Disorder Testing and Positive Airway Pressure Therapy Services and Supplies


Additionally, clinical indications for coverage for certain respiratory, infusion pump, and therapeutic continuous glucose monitors will not be enforced. Impacted DME items are addressed in the current versions of the following policy bulletins:

Policy NumberPolicy Title
MA05.001c High-Frequency Chest Wall Oscillation Devices
MA00.002f Continuous Glucose Monitors and Artificial Pancreas Device Systems (APDS)

Note: Only clinical indications for therapeutic continuous glucose monitors (CGM) are not enforced
MA05.053g Implantable and External Infusion Pumps

Note: Only clinical indications for external infusion pumps are not enforced.


Professional providers and suppliers must still:
  • Provide a standard written order (SWO) for all items. For Power Mobility Devices (PMDs), the professional provider must document and communicate to the DME supplier that the professional provider has had a face-to-face encounter (an in-person or telehealth encounter between a treating professional provider and an individual) with the member within the six months preceding the date of the written order/prescription;
  • Ensure that the items or services are reasonable and necessary;
  • Continue documenting the medical necessity for all services. Accordingly, the medical record must be sufficient to support payment for the services billed (that is, the services were actually provided, were provided at the level billed, and were medically necessary).

The Company may conduct reviews and audits of services to our members regardless of the participation status of the provider. Medical record documentation must be maintained on file to reflect the medical necessity of the care and services provided. These medical records may include but are not limited to: records from the professional provider’s office, hospital, nursing home, home health agencies, therapies, and test reports.



Dosing and Administration

N/A



Black Box Warnings and/or Contraindications

N/A



Coding


N/A




6/30/2020