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CMS Home Health Final Rule and Innovations Assistive Technology Equipment and Supplies

Cardinal Innovations Healthcare — November 01, 2020
Starting November 1, members and their families will not be able to directly request off-list Durable Medical Equipment. Instead, prior approval must be sought first via the Durable Medical Equipment services.

This change follows guidance from N.C. Department of Health and Human Services (DHHS) regarding Centers for Medicare and Medicaid Services (CMS) Home Health Final Rule (Title 42, Section 440.70).

In the past, off-list items could be requested directly through the Innovations Assistive Technology Equipment and Supplies (ATES) service definition. Now, you must get prior approval first. If denied, you can then request the item through ATES.

This change only affects ATES requested items that meet the definition of Durable Medical Equipment or Medical Supplies under Clinical Coverage Policies 5A-1, 5A-2, 5A-3, and 5B. (That includes nutritional supplements.)

For more information, contact your Care Coordinator. 

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