The Department of Human Services, Med-QUEST Division, is providing information
on the receipt of reimbursement increase to PCPs to Medicare rates for primary care services in
CY 2013 and 2014 to Medicaid beneficiaries in the FFS, QUEST and QExA programs.
Click here to view information on this enhanced reimbursement.
Medicaid will be following Medicare with regards to billing for the Non-invasive Open Ventilation System referred to as “Breathe NIOV™”.
In order to insure that Medicaid does not pay for this miscellaneous code (E1399) Medicaid’s claims payment system has been set to require
that any claims billed using a HCPCS code E1399 be medically reviewed. Below is Medicare’s Local Coverage Determination for this equipment:
The Non-invasive OPEN Ventilation System (NIOV™) by Breathe Technologies, Inc. provides positive pressure inspiratory support for patients using oxygen.
The correct HCPCS code to use for billing this item is:
E1399 - DURABLE MEDICAL EQUIPMENT, MISCELLANEOUS
Based on clinical data provided by the manufacturer, this item is effective only when used in conjunction with oxygen; therefore, it is
classified as an accessory to oxygen equipment. Oxygen reimbursement is a bundled payment. All options, supplies and accessories are
considered included in the monthly rental payment.
Note: Numerous sources, including the manufacturer materials and references in published clinical articles, use the term "ventilator"
when discussing this device. For Medicare payment purposes, the NIOV™ device is NOT considered to be a ventilator or any other type
of positive airway pressure device (CPAP, bi-level PAP, etc.). DMEPOS suppliers must not use HCPCS codes assigned to those products
when submitting claims for the NIOV™ device.
The State of Hawaii, Department of Human Services (the State), hereby notifies the public that it intends to seek a five-year renewal of its
Section 1115 demonstration project from the Centers for Medicare & Medicaid Services (CMS). The State expects the current demonstration to
expire on December 31, 2013.
Click below to view the Draft 1115 Application, Quality Assurance Monitoring Info, Behavioral Health Protocol, Behavioral Health Addendums A,B,C, & D
Click here to view the Draft 1115 Application
Click here to view the Quality Assurance Monitoring Info
Click here to view the Behavioral Health Protocol
Click here to view the Behavioral Health Addendum A
Click here to view the Behavioral Health Addendum B
Click here to view the Behavioral Health Addendum C
Click here to view the Behavioral Health Addendum D
The Affordable Care Act, PCIP provides health care coverage for uninsured people with pre-existing conditions until new insurance market rules go into effect
in 2014. PCIP is provided through the U.S. Department of Health and Human Services and administered through the Office of Personnel Management. More information
is available at: www.healthcare.gov
Additional information relating to PCIP is available through the Government Employee Health Association (GEHA). GEHA currently administers PCIP in 20 states.