UnitedHealthcare has delayed implementation of “substantially revised” home medical equipment (HME) order and fulfillment processes linked to Medicare Advantage (MA) plans in Georgia and North Carolina — which can provide a learning opportunity for HME suppliers, according to the American Association for Homecare (AAHomecare).
In a July 22 message to members and industry stakeholders, AAHomecare said UnitedHealthcare will be postponing durable medical equipment (DME) order and fulfillment processes “for members of their MA plans who are enrolled in HME or PPO products in North Carolina and Georgia. The implementation date is being moved back one month, from Aug. 1 to Sept. 1.”
Under the new, delayed program, “suppliers would be part of a capitated arrangement with Synapse Health for standard DME products and supplies,” AAHomecare noted. “This delay offers DME suppliers in North Carolina and Georgia additional time to familiarize themselves with new processes and requirements. Providers in other states should also be interested in learning more about this new model being implemented by a payer with a large national footprint.”
Getting familiar with Synapse Health’s provider handbook
As a result, the association is encouraging suppliers to “thoroughly read and understand the requirements and standards laid out in Synapse Health’s DME Provider Handbook and how they may impact your business.”
While the new policies don’t include Complex Rehab Technology products, they do impact standard wheelchairs and mobility aids, in addition to a host of DME, including diabetic supplies, enteral nutrition, oxygen and respiratory, urological supplies, and wound care.
“AAHomecare members who have reviewed the Provider Handbook have pointed out several requirements and standards that suppliers should note,” the association said. Those include, under DME performance standards, the requirement that the HME business “maintain 24-hour on-call coverage seven days per week and respond to Synapse Health within 30 minutes of call, including after normal business hours, weekends and holidays.”
“AAHomecare met with UnitedHealthcare in late June to discuss the new model,” the association said in the bulletin. “We shared that we had received many calls from our members in Georgia and North Carolina raising concerns.
“AAHomecare asked UnitedHealthcare if PPO patients that have out-of-network coverage and wish to stay with their current provider would have their DME paid for under their out-of-network benefits. United Healthcare responded that they will be working to make sure all patients are transitioned for the ‘good of the patient,’ but they will honor out-of-network benefits for those patients.”
