Questions and Answers about DME Changes
DSHS will no longer cover "oral enteral nutrition" for most adults
When will this change happen?
- Beginning July 1, 2009
What if I use it for Tube Feedings?
- DSHS will still pay for oral nutrition for adults using it for tube feedings.
What if I get oral nutrition now?
- If it was authorized by our department, you will still get it until the end date on the approval letter that was sent to you.
Is there an exception?
- Yes. You may have your doctor ask DSHS for an exception to this policy following the "exception to rule" process in the state's administrative code WAC 388-501-0160.
What about my children?
- DSHS will continue to cover oral nutrition for children.
Can I ask for a fair hearing?
- No. Because the benefit change affects all Medicaid recipients, there is no right for a hearing.
Changes to coverage for Medical Supplies
When will this change happen?
- Beginning August 1, 2009
What won’t be covered?
- For Adults
these items won’t be covered:
- Bath or shower items,
- Stockings and
- Auto blood pressure cuffs.
- DSHS will still pay for these supplies for children.
Is there an exception?
- Yes. You may have your doctor ask DSHS for an exception to this policy following the "exception to rule" process in the state's administrative code WAC 388-501-0160.
What limits are changing?
- Incontinent supplies will be limited to 200 per client per month. This includes briefs only, or a combination of briefs and pull-ups.
- Non-sterile gloves will be limited to 200 per client per month.
- Sterile gloves will be limited to 30 per month.
- Diabetic
supplies (lancets and test strips)
- Clients on insulin, there will be a limit of 100 per month.
- Clients not on insulin, the limit will be 100 every three months.
What if I need more than the limit?
- Have your doctor ask DSHS for authorization or an exception.
Can I ask for a fair hearing?
- No. Because the benefit change affects all Medicaid recipients, there is no right for a hearing.
What help is available for enteral nutrition?
- DSHS has the Basic Food program. Find out more and how to apply at www.foodhelp.wa.gov. Contractors can help low income families and individuals apply for benefits. Use this link to view a list of contractors (pdf)
For comments or questions, email contact us. Last modified: 06/18/2009
