Provider Letter - Bulletine authorization Changes
OKLAHOMA DEPARTMENT OF HUMAN SERVICES
Developmental Disabilities Services Division
Sequoyah Building, 2nd Floor
P.O. Box 25352
Oklahoma City, OK 73125-0352
March 8, 2018
Changes in Authorization of Incontinence Supplies, Compression Stockings, Nutritional Supplements, Home Delivered Meals, and Personal Emergency Response Systems (PERS)
The Medicaid Services Unit – ADvantage Administration (MSU-AA) is modifying the processes for authorization of the above services for ADvantage Members. These changes in processes are implemented as both a cost saving measure related to the FY2018 DHS budget allocation as well as to assure appropriate authorization of Member services. These changes in authorization will be effective Monday, March 19, 2018. New and revised documents required to support the requests are attached. Case Managers should begin using these documents immediately to avoid authorization issues.
Requests for incontinence products will be limited to a maximum quantity of 100 per month, whether for a single product type or in combination, without a prescription. Up to 300 products may be authorized with documented need on the Medical Order for Incontinence Supplies. In the rare event that more than 300 products are required monthly, the prescriber may include supporting documentation to exceed the maximum limit.
Compression stockings may be authorized at a maximum of two (2) pair per year with the Medical Order for Compression Stockings. Compression garments purchased over-the-counter with or without a prescription and having a pressure of less than 18 mmHg (e.g., elastic stockings, surgical leggings, anti-embolism stockings, thromboembolic disease (T.E.D) hose, or pressure leotards) will not be authorized.
A standardized Medical Order for Nutritional Supplements will now be required for all nutritional supplement requests, in addition to the revised Request for Nutritional Supplements form. Authorization will be based on prescriber's recommendation for quantity and frequency.
Home Delivered Meals.
Home delivered meals will be authorized in accordance with Member need as supported on the Request for Home Delivered Meals form. All requests for home delivered meals will now require Clinical Review.
Personal Emergency Response System (PERS.
PERS will continue to be authorized according to Member need as supported by the revised Request for Personal Emergency Response System (PERS) form. Members having cell phone availability and those who do not wear or use their PERS devices may no longer remain eligible for this service. Additionally, eligibility will be reassessed annually versus the current practice of maintaining the service in the home after the initial authorization.
- Medical Order for Incontinence Supplies
- Medical Order for Compression Stockings
- Medical Order for Nutritional Supplements
- Case Manager must complete the following sections of the Order forms prior to providing to Member/prescriber:
- 'Return completed form to' AND
- 'Member Information'
- Request for Home Delivered Meals
- Request for Incontinence Supplies
- Request for Nutritional Supplements*
- Request for Personal Emergency Response System (PERS)*
*Note:Older version of these forms will no longer be accepted beginning March 19, 2018
If you have any questions regarding the information provided above, please feel free to contact us via Smarter Mail at: firstname.lastname@example.org