COVID-19 (Coronavirus): Certain DME requirements waived and clinical indication enforcement relaxed

July 29, 2020

This article was revised on July 29, 2020, to update the effective timeline.

Independence is committed to providing our members with access to the care they need during the COVID-19 pandemic. We encourage all Independence members and providers to visit our dedicated COVID-19 webpage regularly for the latest news and updates. We will continue to evaluate member needs as the situation changes.

Certain requirements waived

Independence will temporarily waive certain requirements for Durable Medical Equipment (DME), as well as prosthetics, orthotics, and supplies as follows:

  • The waiver for Commercial members is effective March 6, 2020, through September 4, 2020. The waiver is subject to re-evaluation for the duration of the public health emergency.
  • The waiver for Medicare Advantage members is effective March 6, 2020, through the duration of the public health emergency.

Independence is waiving signature and proof of delivery requirements for DME when a signature cannot be obtained because of the inability to collect signatures. Suppliers should document in the medical record the appropriate date of delivery and that a signature was not able to be obtained because of COVID-19.

Certain DME, as well as prosthetics, orthotics, and supplies, replacement requirements (i.e., face-to-face requirement, a new professional provider order, and a new medical necessity documentation) may be waived when an item is lost, destroyed, irreparably damaged, or otherwise rendered unusable. Suppliers must still include a narrative description on the claim explaining the reason why the equipment must be replaced and are reminded to maintain documentation indicating that the DME, prosthetics, orthotics, and supplies were lost, destroyed, irreparably damaged, or otherwise rendered unusable or unavailable as a result of the emergency.

Policies

For a complete list of the policies affected by this change, please review the News Article, Waiver of certain requirements during COVID-19 outbreak related to Durable Medical Equipment (DME), prosthetics, orthotics, and supplies, which can be found in the Commercial and Medicare Advantage News & Announcements sections of the Medical Policy Portal.

Relaxed clinical indication enforcement

From March 6, 2020, through the duration of the public health emergency, Independence will not enforce clinical indications for coverage for certain respiratory, infusion pump, and therapeutic continuous glucose monitors for Medicare Advantage members.

Professional providers and suppliers must still:

  • provide a standard written order (SWO) for all items;
  • document and communicate to the DME supplier that the professional provider has had a face-to-face encounter (i.e., an in-person or telehealth encounter between a treating professional provider and an individual) with the member within the six months preceding the date of the written order/prescription for Power Mobility Devices (PMDs);
  • ensure that the items or services are reasonable and necessary;
  • continue documenting the medical necessity for all services. Accordingly, the medical record must be sufficient to support payment for the services billed (that is, the services were actually provided, were provided at the level billed, and were medically necessary).

Policies

The DME items affected by this change are addressed in these Medicare Advantage policies:

  • #MA05.001c: High-Frequency Chest Wall Oscillation Devices
  • #MA00.002f: Continuous Glucose Monitors and Artificial Pancreas Device Systems (APDS)
    • Only clinical indications for therapeutic continuous glucose monitors (CGM) are not enforced.
  • #MA05.053g: Implantable and External Infusion Pumps
    • Only clinical indications for external infusion pumps are not enforced.

Learn more

For more information about Independence’s position on COVID-19, please review the following resources: