Sep 2, 2010

There is a BIG CHANGE for diapers & related items.

The waiver will no longer pay for Durable Medical Equipment & Incontinence Supplies for under age 21 As of Sept 1, 2010 Now it will be paid by Medicaid.

You can see a list of companys that can help you by going to

Medicaid Notice along with Policy Criteria. Please pay extra attention to Documentation and Service Limitations Required.
(Prescription, Measurements, Monthly Record, Quantity).

Policy Criteria for Disposable Incontinence Briefs, Diapers, Protective Underwear, Pull-On's, Liners, Shields, Guards, Pads, Undergarments.

For your convenience, please use this as a reference until the updated
DME handbook is posted on our fiscal agent�s Web site. You will
receive notification when the promulgated handbook has been posted.

Medical Necessity
The disposable incontinence supplies as specified in the section are reimbursable only for use by individuals with chronic incontinence
caused by a permanent physical or mental condition, including
cerebral palsy and developmental delay.

Age Requirements
Disposable Incontinence Briefs, Diapers, Protective Underwear,
Pull-On's, Liners, Shields, Guards, Pads, and Undergarments
are covered for recipients four (4), when a child would normally be expected to achieve continence, through twenty (20) years of age.

To receive incontinence supplies, the following documentation
must be included in the recipient�s record:

� Physician�s prescription, including the specific diagnosis pertaining
to the underlying condition(s) that lead to the need for incontinence
products (the primary ICD-CM code). The prescription must
specify the type of incontinence (the secondary ICD-CM code)
for which the incontinence supplies were prescribed. The prescription
must be written prior to the delivery of supplies.

� Measurements (e.g., waist and hip size, weight) which support reimbursement for the specific size of product supplied.

� Monthly record of specific type, brand, and size of product(s) supplied

� Quantity of disposable supplies needed per month. Documentation must reflect the number of units by which each product is measured. For example, diapers are measured as individual units. If one package of 200 diapers is delivered, the delivery slip or invoice and the claim must reflect that 200 diapers were delivered and not that one package was delivered.

Service Limitations

For recipients four (4) through twenty (20) years of age with a
physical or mental condition that results in chronic incontinence,
diapers, briefs, protective underwear, pull-on's, liners, shields, guards,
pads, undergarments may be reimbursed up to a combined total of
200 per calendar month. Incontinence liners are not menstrual pads. Personal hygiene products such as menstrual pads are not covered.
�Blanket� incontinence supply orders covering more than one patient
or orders not specific to a product type and quantity are not acceptable.