Recently we learned of a appearent glitch in a new system being implemented in September for the Durable Medical Equipment (DME) needs of consumers on MaineCare. The new system being implemented by Mainecare will allow vendors, or the folks people buy equipment from, to submit their claims for prior approval by the DME department of MaineCare.
The problem is best illustrated by discussing how a consumer on MaineCare receives medical equipment, such a a wheelchair. Let's say our consumer's chair is over seven years old. MaineCare guidelines require a consumer wait at least seven years, unless “significant medical decline” can be shown. The requirements for “significant medical decline” can be difficult to almost impossible to meet. A consumer would first need to go to their doctor and get a referral for a “Wheelchair Clinic.” The wheelchair clinic may take up to three months to get an appointment with a professional who can properly fit a wheelchair.
The wheelchair must then be authorized by MaineCare's DME prior authorization department. It needs to be approved by MaineCare before the wheelchair can be ordered, and as wheelchairs are built by manufacturers to the custom specifications of a consumer's prescribed wheelchair. This can take anywhere from four to six or even eight weeks. In August of this year, in preparation for the conversion to the Internet based Claim changes, vendors were told not to deliver any mobility devices to consumers after the 15th, as the paperwork would not be filed by the time the new system was implemented. This probably also was reported as a savings over historic levels, considering there was no implementation of a new system last year, so the state sees this as saving money before the computer system was even installed.
Additionally, vendors who have already had wheelchairs approved for consumers have been told their chairs were not approved. Vendors have had entire applications kicked back to them for a simple errors like the vendor identification number and the date transposed. As vendors are maybe doing paperwork twice a week, as the majority of their time is fitting wheelchairs to consumers, this type of kickback may potentially delay an assistive mobility device further. Other issues, such as having to change cars or vans for transporting a new chair create additional issues that are beyond the scope of this article.
There is always the chance that the new system will correct itself and that any delays will be reduced with the further implementation of the new MaineCare system. The Disability Rights Center can help with Durable Medical Equipment, so if someone you know is having issues, give them a call. They are extremely helpful and know the laws as it relates to DME.