Coronavirus Disease 2019 (COVID-19) Temporary Durable Medical Equipment Updates
On Friday, March 13, 2020, President Donald Trump declared a national emergency due to the coronavirus disease 2019 (COVID-19) and Governor Henry McMaster declared a state of emergency for the state of South Carolina. As a part of the state’s preparation and response to COVID-19, the South Carolina Department of Health and Human Services (SCDHHS) is announcing modifications to policies related to the Medicaid durable medical equipment (DME) benefit.
The temporary policy changes outlined below will give providers needed flexibility to help ensure Healthy Connections Medicaid members continue to have access to care while supporting important social distancing measures. They will remain in effect for the duration of the current declared public health emergency, unless SCDHHS determines they should sunset at an earlier date. SCDHHS will begin accepting claims for these policy changes on April 15, 2020, for dates of service beginning March 15, 2020.
Coverage and Prior Authorizations
SCDHHS is expanding coverage of oxygen therapy to include coverage for acute, short-term treatment. Oxygen therapy must be provided pursuant to a valid medical order. SCDHHS is also waiving the requirement that portable systems be limited to periods when beneficiaries are not able to use stationary systems.
SCDHHS is waiving prior authorization requirements and quantity limits for oxygen therapy, positive airway pressure devices, respiratory assist devices, ventilators, suction devices, nebulizers and related supplies.
Continuity of Care for Medical Supplies
To the extent otherwise allowable by professional licensing boards, professional practice acts, and other laws and regulations, DME providers may continue to provide services, recurring medical supplies or DME rentals with otherwise valid provider orders that exceed SCDHHS’ duration or timeliness standards.
Supporting Hospital Discharges
To facilitate the discharge of Medicaid members from inpatient hospitalization, DME providers may provide and deliver DME items to hospitalized individuals who may not otherwise meet the standards of medical necessity, so long as:
- The discharging hospital or physician attests that the equipment is necessary to support the discharge; and,
- The discharge is consistent with the Centers for Disease Control and Prevention-recommended guidelines for the statewide COVID-19 response.
SCDHHS is waiving place of service edits to allow for this provision.
Requirements for Medicaid Certificates of Medical Necessity (MCMNs) for oxygen, enteral nutrition, parenteral nutrition and medical equipment are suspended. A valid physician order is still required, however, the requirement for an MCMN with a wet-ink signature is waived. DME providers must collect and document all information required on the MCMN and maintain that information in the patient’s record. Information may be collected in writing or telephonically.
SCDHHS is allowing text, email, photographic or confirmed shipment receipts from a third-party shipping company as substitutes for current member signature requirements for proof of delivery.
SCDHHS is monitoring the circumstances surrounding COVID-19 closely and the coverage changes outlined in this bulletin are designed to ensure essential health services that prioritize safety and well-being are provided during periods of social distancing or self-quarantine. Accordingly, Healthy Connections Medicaid members with questions about maintaining scheduled health service appointments should consult with their healthcare provider. Additional guidance and modifications to coverage policy, including habilitative, rehabilitative and behavioral health therapies, along with their effective dates, will be communicated in future bulletins, as needed.
Thank you for your continued support of the South Carolina Healthy Connections Medicaid program.