Acute Medicaid SuppliesAdaptive Aids - PowerPoint PPT Presentation
1 / 15
Title:
Acute Medicaid SuppliesAdaptive Aids
Description:
Adaptive aids/medical supplies are covered by the CBA waiver only after the ... party resources (TPRs), including Medicare and Medicaid Home Health (MHH), that ... – PowerPoint PPT presentation
Number of Views:62
Avg rating:3.0/5.0
Title: Acute Medicaid SuppliesAdaptive Aids
1
- Acute Medicaid Supplies/Adaptive Aids
DADS 2008 Medicaid 1915(c) Waiver
Conference October 27-30, 2008 Austin,
Texas Presented by Gilbert Estrada Program
Specialist Policy Development and
Support Provider Services - Community Services
2
Introduction
- Purpose of Presentation
- To inform attendees of an initiative to
streamline the processes used by Home and
Community Support Services agencies (HCSSAs) to
purchase adaptive aids and medical supplies for
Community Based Alternatives (CBA) consumers. - To supplement information to be presented at the
General Waiver - Adaptive Aids and Home
Modifications session on 10/29 at 11 a.m.
3
Definitions
- Adaptive aids - Devices that are medically
necessary to treat, rehabilitate, prevent, or
compensate for medical conditions resulting in
disability or loss of function. - Adaptive aids enable persons with functional
impairments to perform the activities of daily
living or control the environment in which they
live. - Medical Supplies - Items that either have
therapeutic or diagnostic benefits specific to
the participant's diagnosis and are necessary in
carrying out the individual service plan (ISP).
4
Background
- CBA program rules (48.6050) require HCSSAs to
provide a certain array of home and community
support services in accordance with the CBA
consumers individual service plan (ISP), Form
3671. - Included in that array are adaptive aids and
medical supplies. - The processes that HCSSAs follow to purchase and
deliver adaptive aids and medical supplies are
outlined in Section 4424 of the CBA Provider
Manual.
5
Program Requirements
- The CBA program is not intended to provide every
participant with any and all adaptive
aids/medical supplies the participant may receive
as a nursing facility resident. - HCSSAs must ensure that purchases of adaptive
aids and medical supplies are - cost effective and
- delivered in a timely manner.
- HCSSAs must limit adaptive aids and medical
supplies to the most cost-effective items that
can - meet the participant's needs,
- directly aid the participant avoid premature NF
placement, and - provide NF residents an opportunity to return to
the community.
6
Program Requirements
- The CBA waiver is the last payor for adaptive
aids and medical supplies. - Adaptive aids/medical supplies are covered by the
CBA waiver only after the consumer has exhausted
any third-party resources (TPRs), including
Medicare and Medicaid Home Health (MHH), that he
is eligible to receive. - HCSSAs are required to have knowledge of services
available through Medicare and MHH and not
request services through CBA when the participant
is eligible to receive services from other
resources. - Adaptive aids and durable medical equipment (DME)
are one-time purchases and should not be
authorized through CBA for consumers potentially
eligible for MHH, unless the Texas Medicaid
Healthcare Partnership (TMHP) has denied the
coverage or the HCSSA specifically documents that
the client does not meet MHH eligibility
requirements.
7
Program Requirements
- HCSSAs should not submit adaptive aid requests to
the CBA case manager until a denial is received
from Medicare or Medicaid, or the HCSSA documents
the client does not meet the homebound
requirements. - For lift chairs, Medicare may pay 80 of the lift
mechanism. The lift chair should not be
incorporated into the ISP until approval is
obtained from Medicare for the cost of the lift
mechanism. - Medicare will pay for glucose monitors, test
strips, and lancets for all diabetic clients at
80 of the cost. CBA can cover the 20
co-insurance if no other resources are available.
- Insulin syringes and needles are obtained by the
client through the Health and Human Services
(HHSC) Vendor Drug Program , not through the CBA
program.
8
Issues
- In accordance with program requirements, CBA case
managers request documentation of a TPR denial
before approving adaptive aids and medical
supplies for the CBA waiver consumers ISP. - HCSSAs and DME suppliers advised the State that
the process and documentation requirements for
purchasing adaptive aids/medical supplies are
problematic.
9
The Solution
- A workgroup consisting of representatives from
HHSC, DADS, TMHP, and other stakeholders (HCSSAs,
DME suppliers) met and recommended that the
program requirements be streamlined to - expedite delivery of adaptive aids/medical
supplies, - expedite payment, and
- provide prompt service to CBA consumers.
- Workgroup Recommendations
- The State would create a list of adaptive
aids/medical supplies and identify which items
would never be approved by Medicare/MHH. - Case managers would refer to this list, thereby
eliminating the step to receive a denial letter
from TMHP for these items and. - Case managers would approve these items on the
CBA consumers ISP.
10
The List Major Sections
- Adaptive Aids (Includes repair and maintenance,
to include batteries, not covered by the
warranty.) - Mobility aids (Including batteries and charges)
- Respiratory Aids
- Positioning Devices
- Communications Aids (Including repair,
maintenance, and batteries.) - Control Switches/pneumatic switches and devices
11
The List Major Sections
- Environmental Control Units
- Modifications/additions to primary transportation
vehicles - Sensory Adaptations
- Adaptive Equipment for Activities of Daily Living
- Assistive Devices
- Safety Restraints and Safety Devices
- Medical supplies, necessary for therapeutic or
diagnostic benefits
12
The List Major Sections
- Other types of supplies
- Diapers, linens, and other incontinence supplies
- Nutritional supplements
- Enteral feeding formulas and supplies
- Diabetic supplies (strips, lancelets, syringes)
- Transcutaneous Electrical Nerve Stimulations
(TENS) - Stethoscopes, blood pressure monitors, and
thermometers for home use - Blood glucose monitors
13
Implementation Plan
- Coordinate with HHSC and TMHP to finalize list of
adaptive aids/medical supplies - Present list to external stakeholders for review
- Determine implementation date
- If necessary, revise program rules, provider
policy, and case manager policy - Notify staff/providers of revised policy and
procedures
14
QUESTIONS???
15
Contact Information
- Gilbert Estrada
- DADS CBA Provider Policy Specialist
- gilbert.estrada_at_dads.state.tx.us
- (512) 438-2578
Recommended
CrystalGraphics Presentations
