NPs and PAs are now allowed to order DME!

Posted 7 months ago by Karin Iuliano

This announcement has 1 attachment:

April 8, 2020

MEDICAID INFORMATION RELEASE MA20-08

To: All Medicaid Providers

From: Matt Wimmer, Administrator

Subject: Medicaid Provider Information Regarding Durable Medical Equipment (DME)


The Idaho Department of Health and Welfare continues to monitor and prepare for impacts resulting from the 2019 Novel Coronavirus (COVID-19). During this time, it is vitally important that Medicaid participants receive services and get their needs met.

To this end, Idaho Medicaid is temporarily making changes to its Durable Medical Equipment policy. These changes will allow: • Advance practice registered nurses and physician assistants to order equipment and supplies. • Suppliers to provide up to ninety (90) days of supplies in a ninety (90) day period. • Supplier claims for items shipped to the participant to be billed with the date of the shipment.

These changes are effective for dates of service as of the date of this notice and apply to all services billed through fee-for-service Medicaid (claims processed by DXC, formerly Molina Medicaid Solutions). This guidance does not apply to services paid through managed care plans for individuals eligible for both Medicare and Medicaid administered by Blue Cross of Idaho or Molina Healthcare of Idaho. Because of the need to coordinate with Medicare policy changes, please contact the plan administrator directly with questions.

These changes will assist in decreasing contact between people to inhibit the spread of the virus. Allowing non-physician practitioners to order will increase access by removing barriers. Receiving supplies for a longer period will also assist participants in case there are disruptions to delivery and supply chains.

Suppliers shipping equipment and supplies through a third-party can use the date of shipment as the date of service on claims instead of date of delivery. Proof of delivery is still required. This allows suppliers to make good faith efforts to deliver necessary services to participants with the expectation of reimbursement.
Information Release MA20-08 April 8, 2020 Page 2 of 2


Because of the need to respond quickly, our system is not yet fully configured to support all coverage and some claims may not pay immediately. Our systems team is working on necessary changes to effectuate this policy and will reprocess claims to ensure appropriate payment consistent with this policy as soon as possible.

We thank you for your service to Idaho Medicaid participants and appreciate your work to address this public health threat.


MW/cab