DOH Issues Guidance for MLTC Billing of DME Supplies

DOH has issued MLTC Policy 13.20, Provision of DME (durable medical equipment) Supplies through Pharmacy, detailing expanded edits of the existing pharmacy fee-for-service system. DOH is seeking to prevent MLTC plans from inappropriately claiming certain DME for which they are responsible under capitation, including items like syringes and needles. According to the policy, the edit that is now precluding the billing for such items will be temporarily disabled beginning Aug. 22 to allow plans to receive these necessary items until contracts are in place with pharmacies and the plans can update provider networks. MLTCPs are also advised that they should ensure systems are in place so members can obtain syringes and needles until the edit is relaxed. Plans must have contracts in place by Nov. 1, 2013.

Contact: Patrick Cucinelli, pcucinelli@leadingageny.org, 518-867-8827