Self-Administered Oxygen-Hospital Discharges

Effective June 1, 2014, South Carolina Department Health and Human Services will amend the non-emergency transportation policy for self- administered oxygen dependent beneficiaries discharged from inpatient hospitals or emergency rooms.  This policy change affects Hospitals, Physicians, Ambulance and Durable Medical Equipment (DME) providers.  This policy change will also be posted in the Hospital, Physicians Laboratories and Medical Professional, Ambulance and Durable Medical Equipment manuals located on the SCDHHS website: www.scdhhs.gov.  

The policy applies to beneficiaries who are admitted as an inpatient of a Hospital or Hospital Emergency Room, are oxygen dependent, do not have their portable oxygen system in their possession, and do not require transportation via ambulance for the return trip to their residence for any other reason. The Hospital is responsible for arranging and acquiring a portable oxygen system complete with all medically necessary accessories upon discharge. Hospitals and Ambulance providers will no longer receive reimbursement for non-essential, non-medically necessary ambulance transportation for self-administered oxygen dependent beneficiaries.

It is the responsibility of both the Hospital and DME provider to coordinate and dispense oxygen to the Medicaid beneficiary while admitted to the Hospital or Hospital Emergency Room in order for the appropriate mode of non-emergency transportation to be arranged with the transportation broker upon discharge. The dispensing DME provider will be responsible for arranging the return of the portable oxygen system at time of discharge from the admitting Hospital facility.

The physician or hospital personnel must arrange for a Medicaid enrolled DME provider to dispense the medically necessary portable oxygen system prior to discharging the patient from the Hospital and contact the transportation broker for non-emergency transportation when needed. SCDHHS will reimburse for a portable oxygen system, E0443 billed with a U1 modifier, and the dispensing provider will be reimbursed at a rate of $20.00 per occurrence. SCDHHS will limit the number of occurrences per patient to no more than three occurrences per calendar month. Services that exceed the three occurrences per calendar month will not be reimbursed.

EMS providers whenever possible should transport oxygen dependent beneficiaries with the beneficiary's personal portable oxygen system in anticipation of the beneficiary's medical/health needs. All services are subject to post payment review by Program Integrity.

Thank you for your continued support of the South Carolina Healthy Connections Medicaid program.

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