C.M.R. 10, 144, ch. 101, ch. I, § 144-101-I-5, subsec. 144-101-I-5.05

Current through 2024-51, December 18, 2024

Subsection 144-101-I-5.05 - MEDICAL SUPPLIES AND DURABLE MEDICAL EQUIPMENT

A.COVID-19-Related Supplies and Durable Medical Equipment: Prior Authorization approvals currently in effect for Section 60, Durable Medical Equipment (DME), will be extended for individuals with COVID-19 (who should be in quarantine), individuals with pending COVID-19 tests in self-isolation, and individuals in the high-risk category for developing severe complications from COVID-19, and early refills will be temporarily allowed as follows on the following DME items:

1. Glucose supplies;

2. Hearing aid batteries; and 3. The following Continuous positive airway pressure (CPAP) and bi-level positive airway pressure (Bi-PAP) supplies:

a. Oral/nasal mask - one (1) per three (3) months;

b. Oral cushion- two (2) per one (1) month;

c. Nasal pillow - two (2) per one (1) month;

d. Full face mask - one (1) per three (3) months;

e. Facemask interface - one (1) per one (1) month;

f. Nasal interface - two (2) per one (1) month;

g. Tubing - one (1) per one (1) month;

h. Tubing (with heating element) - one (1) per three (3) months;

i. Filter (disposable) - two (2) per one (1) month;

j. Oral interface - one (1) per three (3) months; and

k. Water chamber - one (1) per one (1) month.

B. Extension of Prior Authorizations set to end will be temporarily allowed, when applicable, for the following:

1. CPAP and Bi-PAP devices and supplies;

2. Home blood glucose monitors and test strips;

3. Enteral and Parenteral nutritional therapy;

4. Apnea Monitors;

5. External Insulin Infusion Pumps;

6. Infusion Pumps Other than Insulin Pumps;

7. Continuous Glucose Monitors; and

8. Home Use of Oxygen.

C. The Department authorizes and adds Advanced Practice Providers (Physicians Assistants, Nurse Practitioners, and Clinical Nurse Specialists) to Section 60.05-1(B) to prescribe Durable Medical Equipment.* **

D. The Department waives the requirement under Section 60.12 K that a qualified MD, DO, PA or APRN must prescribe the order. A note from an audiologist will justify medical necessity when all other criteria are met.* **

*The Department shall seek and anticipates receiving approval of these changes from CMS retroactive to March 18, 2020. Pending approval, these changes are effective upon adoption.

**The Department may implement these changes permanently through separate rulemaking in MBM, Chs. II and III, Section 60 (Durable Medical Equipment).

C.M.R. 10, 144, ch. 101, ch. I, § 144-101-I-5, subsec. 144-101-I-5.05