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Replacement schedules/quanities for CPAP supplies with New York State medicaid?
#1
Replacement schedules/quanities for CPAP supplies with New York State medicaid?
Does any one know of a resource that would summarize the allowable replacement schedules/quantities for CPAP supplies with medicaid in New York State? 

For the past five years I have received:

Every 2 weeks:
Mask cushions and/or nasal cushions
Disposable CPAP machine filters

Every 3 months:
Mask frame (not including the headgear)
CPAP tubing (heated or standard)

Every 6 months:
Mask headgear
Chin strap
Humidifier water chamber

I have searched and searched online. Medicaid office says there is an official amount (I am sure there must be!) but no one can actually find out what it is (I am still waiting for a callback form them).

I have been having a back and forth struggle with my DME (CrApria) on the amounts and frequency of replacement supplies. 

My insurance company Healthfirst Managed Medicaid is not very helpful, and only says they will pay for whatever is "medically necessary". 

Thanks
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#2
RE: Replacement schedules/quanities for CPAP supplies with New York State medicaid?
Medicare is a federal program, so I don't think you need to find a NY-specific source.

https://www.google.com/url?sa=t&source=w...LZj_cNuSOi
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#3
RE: Replacement schedules/quanities for CPAP supplies with New York State medicaid?
The OP is on Medicaid, and I believe each state runs their own program.

I do believe, however that Medicaid is supposed to follow the Medicare replacement schedule.

Here are a couple articles that may help. Not Medicaid or NY state Specific, but may help.

http://www.apneaboard.com/wiki/index.php...with_a_DME

http://www.apneaboard.com/wiki/index.php...6_Medicare

By the way, you don't have to use Apria. You should have some other choices under Medicaid in NY state.
OpalRose
Apnea Board Administrator
http://www.ApneaBoard.com

_______________________
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INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE.  ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA.  INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#4
RE: Replacement schedules/quanities for CPAP supplies with New York State medicaid?
Thanks OpalRose, I learn something new every day  Smile
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#5
RE: Replacement schedules/quanities for CPAP supplies with New York State medicaid?
In can anyone else come to this post looking for similar info:

I found what seems to be the current New York State medicaid guidelines for allowed quantities and frequency CPAP supplies. It is the "DME_Fee_Schedule" spreadsheet https://www.emedny.org/ProviderManuals/ ... hedule.xls

which is found on from the site https://www.emedny.org/ProviderManuals/DME/index.aspx

Please note, as per the document 
https://www.emedny.org/ProviderManuals/ ... ptions.pdf
that the “MAX UNITS” column is “for medical/surgical supplies, the maximum allowed per month”.
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#6
RE: Replacement schedules/quanities for CPAP supplies with New York State medicaid?
(03-15-2022, 05:41 PM)OpalRose Wrote: The OP is on Medicaid, and I believe each state runs their own program.

I do believe, however that Medicaid is supposed to follow the Medicare replacement schedule.

Here are a couple articles that may help.  Not Medicaid or NY state Specific, but may help.

http://www.apneaboard.com/wiki/index.php...with_a_DME

http://www.apneaboard.com/wiki/index.php...6_Medicare

By the way, you don't have to use Apria.  You should have some other choices under Medicaid in NY state.

Thank you for your reply and for the links/info!  Thanks
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#7
RE: Replacement schedules/quanities for CPAP supplies with New York State medicaid?
This applies to PA where I reside, while waiting on Disability to be approved, I was on Medicaid through United Healthcare. Their schedule was identical to Medicare. For the DME selection, I was expected to use a national, Apria, Rotech, or Lincare. If I recall correctly, I had to go via an exemption to get a different DME selection approved. Hint, impossible to get it. And I had to use a DME billing office within my state.
Dave

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INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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