Medicaid Policy for Durable Medical Equipment, Prosthetics, Orthotics, and Supplies for Members in Residing in Nursing Homes
4/17/2023
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Posted by Provider Relations
Fidelis Care would like to remind providers that most Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) for members residing in Nursing Homes are included in the rate paid to the facility.
DMEPOS providers should confirm where the member resides, and if the member resides in a nursing home or facility, the provider should ensure the items are not included in the facility’s rate before billing Medicaid fee-for-service or the managed care plan. Payment will not be made for items provided by a facility or organization when the cost of these items is included in the rate.
Custom-made DEMPOS require the Medicaid member be measured and the custom-made item be fabricated from these measurements, and they are not included in the rate. Custom-made DEMPOS are defined as any durable medical equipment, orthopedic footwear, orthotics, or prosthetics fabricated solely for a particular Medicaid member which cannot be readily changed to conform to another member's needs.
If you have any further questions, please contact your Provider Relations Specialist. Fee-for-service questions should be directed to OHIPMEDPA@health.ny.gov.