24.5.13 Incontinence Supplies and EquipmentIncontinence supplies and DME are defined as disposable supplies such as diapers, briefs, pull-ons, liners, wipes, underpads, skin sealants, protectants, moisturizers, ointments, and DME that are used by a client who has a medical condition that results in a chronic impairment of urination and/or stooling, or that renders them unable to ambulate safely to the bathroom (with or without mobility aids). For the purpose of this policy, a chronic impairment of urination and/or stooling is defined as a condition that is not expected to be medically or surgically corrected and that is of a long and indefinite duration (at least three months). Incontinence supplies, urinals, and bed pans do not require prior authorization up to their allowed maximum limitations. Prior authorization is required for incontinence supplies if amounts greater than the maximum limits are medically necessary. Incontinence supplies billed for a one-month period should be based on the frequency/quantity ordered by the physician on the Home Health Services (Title XIX) Durable Medical Equipment (DME)/Medical Supplies Physician Order Form. All claims submitted for DME supplies must include the same quantities or units that are documented on the delivery slip or invoice and on the Home Health Services (Title XIX) Durable Medical Equipment (DME)/Medical Supplies Physician Order Form. They must reflect the number of units by which each product is measured. For example, diapers are measured as individual units. If one package of 300 diapers is delivered, the delivery slip or invoice and the claim must reflect that 300 diapers were delivered and not that one package was delivered. Diaper wipes are measured as boxes/packages. If one box of 200 wipes is delivered, the delivery slip or invoice and the claim must reflect that one box was delivered and not that 200 individual wipes were delivered. There must be one dated delivery slip or invoice for each claim submitted for each client. All claims submitted for DME supplies must reflect the same date as the delivery slip or invoice and the same timeframe covered by the Home Health Services (Title XIX) Durable Medical Equipment (DME)/Medical Supplies Physician Order Form. The DME Certification and Receipt Form is still required for all equipment delivered. To request prior authorization for incontinence supplies/equipment, the following documentation must be provided:
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• Additional information may be requested to clarify or complete a request for the supplies and equipment. The Home Health Services (Title XIX) Durable Medical Equipment (DME)/Medical Supplies Physician Order Form is valid for up to, but no more than, six months from the date of the physician's signature on the form. Note: THSteps-eligible clients who qualify for medically necessary services beyond the limits of this Home Health benefit will receive those services through THSteps-CCP. Refer to: Section 24.3.1, "Eligibility." |
Diagnostic information pertaining to the underlying diagnoses/conditions, to include the client's overall health status.
