Physician Certification of Incontinence

 

In §6407 of the Affordable Care Act (Pub.L. 111-148) Congress added some conditions on the coverage of Durable Medical Equipment (DME).  The Centers for Medicare and Medicaid Services (CMS) has proposed implementing changes to the DME regulations which also clarify the federal agency’s position as to the availability of incontinence and other supplies and equipment under the Medicaid State Plan Home Health benefit.  See 76 FR 41032–41039 (July 12, 2011).

In anticipation of these changes, the South Carolina Department of Health and Human Services is issuing this Bulletin which sets forth the interim policy for obtaining physician certification of incontinence supplies as a State Plan Service under the Home Health regulations at 42 CFR §440.70.  An order must be obtained from the primary physician that the beneficiary is incontinent using the Physician Certification of Incontinence DHHS Form 168IS, which is attached. 

The Physician Certification of Incontinence DHHS Form 168IS is mandatory for all beneficiaries receiving incontinence supplies as a State Plan Home Health benefit with the following effective dates:

  • January 1, 2013 for beneficiaries in the Medically Complex Children’s (MCC) waiver, Ventilator Dependent waiver and Community Support (CS) waiver.
  • April 1, 2013 for beneficiaries in the Head and Spinal Cord Injury (HASCI) waiver, Intellectual Disabilities/Related Disabilities (ID/RD) waiver, Community Choices waiver and HIV/AIDS waiver.
  • July 1, 2013 for non-waiver, fee for service beneficiaries.

The Physician Certification of Incontinence DHHS Form 168IS must be completed by the primary physician initially and every 12 months at a minimum.

Please visit www.scdhhs.gov for additional information on the Medicaid State Plan Home Health incontinence policy. Thank you for your continued support of the South Carolina Medicaid program.

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