Summary
Michigan Medicaid requires a face-to-face visit before the initial written order and delivery of the durable medical equipment and medical supplies listed in Attachment A, as implementation of the ACA home health rule. The visit must be within six months prior to the initial written prescription or order, and the ordering physician must certify that it occurred. Implementation is contingent upon State Plan Amendment approval from the Centers for Medicare & Medicaid Services (CMS), and Medicaid Health Plans are not required to implement this rule.
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What to do
Action · 9 steps
01Already effective July 1, 2018: Before the initial written order and delivery of an item listed in Attachment A, the beneficiary must have had a face-to-face visit with a physician or non-physician practitioner within six months prior to the written prescription or order.
02The ordering physician must certify that the face-to-face visit occurred, whether the physician or another treating physician or practitioner performed it, and must document the date of the visit, the name of the practitioner who performed the evaluation, the clinical findings supporting the need for the item, and the primary reason for the visit.
03Physician orders for these items must be written by a physician, and MDHHS recommends including the face-to-face visit information on the written order or the certificate of medical necessity (CMN).
04The DME provider must date stamp the order, CMN or other documentation containing the face-to-face information upon receipt, keep it in the beneficiary file, and make it available upon request.
05For items requiring prior authorization, the face-to-face documentation must accompany the other required documentation with the prior authorization request.
06A new face-to-face visit is required for an initial order for rental or purchase, new prescriptions or orders, replacement of base equipment, a change in the prescription or order, a change in supplier when the new supplier cannot obtain the original order and documentation, and a change in state or federal law, policies or regulations.
07The face-to-face requirement does not apply to supply refills, equipment repairs, servicing of equipment, or accessories for base equipment, but the ordering physician must assess the continued need for supplies or equipment annually, and refill orders must indicate renewal.
08Providers should check with Medicaid Health Plans to determine whether the plans apply this rule.
09Check current applicability of this 2018 bulletin before billing.
Codes mentioned
E0185E0188E0189E0194E0197E0198E0199E0250E0251E0255E0256E0260E0261E0265E0266E0290E0291E0292E0293E0294E0295E0296E0297E0301E0302E0303E0304E0424E0431E0434E0439E0441E0442E0443E0444E0462E0470E0471E0480E0482E0483E0484E0570E0575E0585E0601E0607E0636E0650E0651E0652E0655E0656E0657E0660E0665E0666E0667E0668E0669E0671E0672E0673E0720E0730E0731E0747E0748E0760E0784E0840E0850E0958E0959E0960E0961E0966E0967E0968E0969E0971E0973E0974E0978E0980E0981E0982E0983E0984E0986E0990E0992E1014E1015E1020E1028E1029E1030E1037E1038E1039E1161E1227E1228E1232E1233E1234E1235E1236E1237E1238E1296E1297E1298E2502E2506E2508E2510K0001K0002K0003K0004K0005K0006K0007K0009K0606
Original notice
MSA 18-17
michigan.gov · Always check the source before changing claims.
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