Commonwealth of Massachusetts Executive Office of Health and Human Services Office of Medicaid www.mass.gov/masshealth MassHealth Durable Medical Equipment Provider Bulletin 18 May 2012 TO: Durable Medical Equipment Providers Participating in MassHealth FROM: Julian J. Harris, M.D., Medicaid Director RE: Clarification of Policy for Members’ Home Use of Nebulizers Background This bulletin clarifies MassHealth’s policy about how durable medical equipment providers may deliver, set up, and instruct MassHealth members on how to use nebulizers in their home to ensure access for members who have an immediate need for home use of nebulizers. The Division of Health Care Finance and Policy (DHCFP) regulations at 114.3 CMR 22.00 (Durable Medical Equipment, Oxygen and Respiratory Therapy Equipment) establish the MassHealth payment rate for the purchase and rental of oxygen and respiratory therapy equipment, including nebulizers (Service Code E0570), furnished to publicly aided individuals by MassHealth DME and OXY providers. Pursuant to 114.3 CMR 22.03(4), the payment for the provision of nebulizers includes, but is not limited to, the following: * costs to deliver the device (24-hours/day); * set-up of the device; and * demonstration and instruction on how to safely use the device. MassHealth durable medical equipment (DME) and oxygen and respiratory therapy equipment (OXY) providers must comply with these DHCFP regulations in addition to applicable MassHealth regulations. Clarification on Nebulizer Some members may require the immediate use of a nebulizer at home Home Deliveries following a visit to a physician office, clinic office, or acute inpatient hospital. To ensure immediate access for these members, MassHealth encourages DME and OXY providers to partner with freestanding and hospital-based physician offices, clinic offices, and acute inpatient hospitals by leaving a limited number of “loaner” (used) nebulizers and supplies at these settings. Physician offices, clinic offices, and acute inpatient hospitals are encouraged to send these loaner nebulizers home with the member on a temporary basis, and to forward required documentation to the DME or OXY provider to initiate the delivery, set-up, and instruction to the member (or caregiver, if applicable) by the DME or OXY provider in the member’s home on how to use the new machine. At the time of home delivery, the DME or OXY provider must remove the “loaner” nebulizer from the member’s home, return it to the DME or OXY provider’s service location, clean it, and, if applicable, restock the physician office, clinic, or acute inpatient hospital with additional loaner nebulizers. OXY and DME providers may submit claims for payment for the provision of new nebulizers to MassHealth. The date of service on the claim must be the date on which the new nebulizer was delivered to the member’s home. Questions If you have any questions about the information in this bulletin, please contact MassHealth Customer Service at 1-800-841-2900, e-mail your inquiry to providersupport@mahealth.net, or fax your inquiry to 617-988-8974.