Durable Medical Equipment

Durable Medical Equipment

Separating Enteral and Parenteral Nutrition Policies

The South Carolina Department of Health and Human Services (SCDHHS) has clarified policies related to enteral and parenteral nutrition. Policies related to the coverage of these services can be viewed in the Durable Medical Equipment (DME) Provider Manual, https://www.scdhhs.gov/provider-type/durable-medical-equipment-manual-120104-edition-posted-111905.

Please refer any questions or concerns regarding this alert to the Provider Service Center at (888) 289-0709. 

Durable Medical Equipment Medicaid Certificate of Medical Necessity (MCMN) CPAP Signature Requirement Modifications

The South Carolina Department of Health and Human Services (SCDHHS) is amending physician signature requirements for continuous positive airway pressure (CPAP) and bi-level positive airway pressure (BiPAP) devices. Effective March 1, 2018, the date of the physician's order, resulting from sleep study interpretation, must be within 90 days before the date of service on the Medicaid Certificate of Medical Necessity (MCMN). For service dates before March 1, 2018, providers will continue to abide by the requirement that physician signatures are required once every 60 days. 

Durable Medical Equipment Medicaid Certificate of Medical Necessity Signature Requirement Modifications

The South Carolina Department of Health and Human Services (SCDHHS) is amending current physician signature requirements for the following forms located in the Durable Medical Equipment (DME) Provider Manual:

1. DME 001 (Equipment and Supplies)

2. DME 003 (Power/Manual Wheelchairs and/or Accessories)

3. DME 004 (Orthotics, Prosthetics and Diabetic Shoes)

Ventilator Guidelines

Effective Dec. 1, 2017, the South Carolina Department of Health and Human Services (SCDHHS) will add criteria and prior authorization guidelines for ventilators to the Durable Medical Equipment (DME) Provider Manual for DME providers. This policy will be posted in the DME Provider Manual located on the SCDHHS website, www.scdhhs.gov.

The ventilator policy guidelines are as follows:

2016 Provider Revalidation: Group 1

The South Carolina Department of Health and Human Services (SCDHHS) is beginning 2016 Provider Revalidation. Durable Medical Equipment and Rehabilitative Behavioral Health Services providers who enrolled as a Healthy Connections Medicaid provider between Dec. 1, 2012-Dec. 31, 2013, are scheduled for revalidation in 2016.

Delivery of Medical Equipment and/or Supplies

Effective Aug. 1, 2015, the South Carolina Department of Health and Human Services (SCDHHS) will amend the delivery method policy for Durable Medical Equipment (DME) providers. This policy change will be posted in the DME manual located on the SCDHHS website, www.scdhhs.gov.

MCMN Exception for Incontinence Providers

Effective July 1, 2015, the South Carolina Department of Health and Human Services (SCDHHS) will no longer require incontinence supply providers to obtain a Medicaid Certificate of Medical Necessity (MCMN) (Form DME001) for gloves provided to Healthy Connections Medicaid members enrolled in the Community Support Waiver, Head and Spinal Cord Injury Waiver and Intellectual Disabilities/Related Disabilities Waiver. Incontinence supply providers are responsible for obtaining the Physician Certification of Incontinence, SCDHHS Form 168IS, prior to delivering incontinence supplies.

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.  

Revised South Carolina Medicaid Diabetic Meters and Strips Program

 

Effective immediately the following National Drug Codes (NDCs) may be billed through the Point of Sale (POS) system and do not require Prior Authorization: 

 

METERS

Manufacturer

National Correct Coding Initiative

 

Effective on or after October 1, 2012, the South Carolina Department of Health and Human Services (SCDHHS) will implement the National Correct Coding initiative (NCCI) Procedure to Procedure (PTP) edits for Durable Medical Equipment (DME).  This will affect services related to wheelchair bases (WCB), wheelchair options and accessories (WCOA), and wheelchair seating (WSC).

 

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