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APA WF 21-05A Medicaid Expansion and Durable Medical Equipment

Please note, several of the changes regarding durable medical equipment have previously been approved by the OHCA Board of Director and the Governor and are currently in effect as emergency rules. 

The proposed rule changes will expand Medicaid eligibility for individuals defined by 42 Code of Federal Regulations § 435.119 who are age nineteen (19) or older and under sixty-five (65), at or below 133 percent of the federal poverty level (FPL), and who are not categorically related to the aged, blind, or disabled.

Additional revisions are needed to comply with the Home Health final rule in which the durable medical equipment and supplies benefit was revised from an optional benefit to a mandatory benefit and was made subject to the scope of the home health benefit.  Prosthetics and orthotics are under a separate regulation and remain an optional benefit. 

Please view the circulation document here: APA WF 21-05A, and submit feedback via the comment box below. 

Circulation Date: 04/21/2021  

Comment Due Date: 05/05/2021

Medical Advisory Committee (MAC) Meeting: 05/13/2021

Board Meeting: 05/19/2021


Stan P Ruffner:
Please review and clarify the language in the current proposed rule APA WF 21-05A regarding "continuous rental" in the definition of capped rental.

Capped Rental refers to "continuous rental" of 13 months - there are many instances where a member may use a capped rental item for less than 13 months due to a gap caused by hospitalization or other unexpected gap reason and then begin a continuation after a 60-90 day gap

It is my understanding that Medicare allows the 13 month period to begin again if there is a verifiable gap cause.

You may want to clarify the definition of "continuous use"

Two followup questions:

Oxygen is not covered for members residing in long term facilities after 10/1/21

CPAP is a covered item after 10/1/21

Last Modified on May 06, 2021