01Already effective December 1, 2022 (Stage 1) and January 1, 2023 (Stage 2): Billing team: Obtain prior authorization again for Stage 1 and Stage 2 items listed in Attachment A that require it, and for replacement of DMEPOS items.
02Enteral formula and supplies that require prior authorization are handled through the Telephone PA Contractor, and the provider should note on the request that CMN and other documentation were waived per MSA 20-14 and add that note to the beneficiary file.
03Stop billing hand sanitizer (HCPCS A9286), because MDHHS ended coverage.
04Stop billing home-use spirometers, which are included in outpatient clinic services.
05Remove the temporary labor units from wheelchair battery HCPCS codes, because temporary PHE fees revert to pre-PHE rates.
06Stop submitting invoices for manually priced items through the Document Management Portal, and submit them to the Program Review Division or the Telephone PA Contractor, as applicable.
07Documentation: Restore pre-pandemic documentation requirements, such as certificates of medical necessity (CMNs), documentation timelines, and lab tests, as described in the Medical Supplier Chapter of the Medicaid Provider Manual.
08Practitioner orders written on or before each stage's effective date continue to be honored, provided the order is less than 12 months from the practitioner's original signature date.
09When an original order expires, a new order, CMN, and other applicable documentation are required.
10Monitor beneficiary files and coordinate with beneficiaries and their practitioners.
11Keep all documentation in the beneficiary's file and available on request.
12Billing for items without the required documentation is not compliant with Medicaid policy and could result in post-payment recovery of funds or provider audit.
13For beneficiaries enrolled in a Medicaid Health Plan or Integrated Care Organization, check the plan's prior authorization requirements.
14Stage 2 prior authorization requests needed for a January 1, 2023 start date had to be received between December 1, 2022 and January 31, 2023, and PA processing takes 15 business days.
15Long-term oxygen users (on oxygen Previously due March 1, 2020 (date passed; verify current applicability)) need a new PA with documentation for dates of service on and after the end of the prior order, and the practitioner order requirement was not waived during the PHE.