This “may” be region-specific, but at least for Jurisdiction C for Medicare, a person living in a nursing home for the purpose of receiving custodial care services (i.e., help with ADLs including assistance to take medication) does qualify for Medicare reimbursement for a communication device as long as the claim is billed to show code 33 for custodial care rather than 31 for skilled care (i.e. skilled rehab care or skilled medical care) and the claim is accompanied by a letter from the nursing home stating that the care is custodial.  Part of the issue seems to be that SNFs offer two types of care: long-term custodial and short-term rehab.  Below is an email that I sent to a physician who asked me to look into this same possibility.  The info came from Dynavox’s funding specialist for Florida and I subsequently emailed the Medicare DMERC for jurisdiction C and received confirmation that this information is correct.  I had always been told that Medicare would not pay for an AAC for a person in a nursing home, so I am looking for a test case.  If anyone has ‘tested’ this reimbursement method (submitting the claim using code 33 for place of service and including the letter confirming the custodial nature of the services) and received Mecicare reimbursement for an AAC while residing in an SNF, I would be very interested in knowing this.  Thanks! 

 

Judie Benwick

Care Coordinator

The ALS Association Florida Chapter

 

Lisa Mathews from Dynavox advised me on March 8th that patients who are residing in a skilled nursing facility but are receiving only custodial type services (i.e., assistance with ADL’s) qualify for Medicare reimbursement for a communication device.  Medicare requires a letter from the SNF (on their letterhead) that states the following “The patient is receiving custodial care services, not skilled care services, in our facility.” 

 

Lisa also provided this documentation below to support eligibilty for Medicare reimbursement when the patient is receiving custodial care services rather than skilled care services.  Apparently it is a matter of providing a letter from the facility to confirm the care is custodial and coding the place of service as a 33 (custodial) rather than 31 (skilled care) on the claim form that Dynavox submits when the claim is sent to Medicare.  Lisa Mathews can be reached at 800-344-1778, ext. 5941 or 412-297-5941 if you would like to speak with her to see how you and Dynavox might be able to work this out. 

 

From http://www.cignagovernmentservices.com/jc/pubs/pdf/2007_winter/2007_winter_SM.pdf

Chapter 6, pages 8,9

 

Claim Submission Chapter 6

Place of Service

Coverage for any DMEPOS items will be considered if the place of service is:

01 Pharmacy

04 Homeless Shelter

09 Prison/Correctional Facility

12 Home

13 Assisted Living Facility

14 Group Home

33 Custodial Care Facility (see definition below)

54 Intermediate Care Facility/Mentally Retarded

55 Residential Substance Abuse Treatment Facility

56 Psychiatric Residential Treatment Center

65 End Stage Renal Disease Treatment Facility (valid POS for Parenteral Nutritional Therapy

 

 

From: http://www.cms.hhs.gov/MedHCPCSGenInfo/Downloads/Place_of_Service.pdf

 

Listed below are place of service codes and descriptions. These codes should be used on professional claims to specify the entity where service(s) were rendered.

 

31	Skilled Nursing Facility	A facility which primarily provides inpatient skilled nursing care and related services to patients who require medical, nursing, or rehabilitative services but does not provide the level of care or treatment available in a hospital.
33	Custodial Care Facility	A facility which provides room, board and other personal assistance services, generally on a long-term basis, and which does not include a medical component.

 

 

 

 

Amy,

 

Thank you so much for your response. I imagine that I will utilize your resources in the near future! I am going to give the patients family a call and see what they'd prefer to do. I have borrowed a device from a local SLP here and I'm going to see if they're interested in this device. If not I will certainly contact you.

 

Also, I have a random question for you. If a patient is just in skilled nursing but not on hospice, and they have medicare, can we fund a device for them?

 

Thanks Amy.

 

Erin Singleton M.A., CCC-SLP
Neuroscience Outpatient Rehabilitation Center
2335 East Kashian Lane, Suite 301
Fresno, California 93701
Office: (559) 459-6056
Cell: (559) 250-1949
Fax: (559) 459-2957
Email: xxxxxx@xxxxxxxxxxxxxxxxxxxx

 

From: xxxxxx@xxxxxxxxxxxxxxxxxxxx [mailto:xxxxxx@xxxxxxxxxxxxxxxxxxxx] On Behalf Of Amy Roman
Sent: Thursday, April 01, 2010 4:20 PM
To: xxxxxx@xxxxxxxxxxxxxxxxxxxx
Subject: Re: Device suggestions for ALS patient on Hospice and in Skilled

Hi Erin, I run the Greater Bay Area ALSA Communication Lending Library.  Good news- Fresno is in our territory and we have a LightWriter or a DynaWrite for your patient!  We require that borrowers work with a (local when possible) SLP who can provide evaluation and training on the device.  Luckily they are working with you.  The family will also have to fill out a loan agreement form and be responsible for returning the device when it is no longer needed.  Please let us know how we can help.  Sincerely, Amy Roman, MS, CCC-SLP Augmentative Communication Specialist Forbes Norris ALS Research Center 2324 Sacramento Street San Francisco, CA 94115 P (415)600-1263 F (415)673-5184 CONFIDENTIAL OR PRIVILEGED: This communication contains information intended only for the use of the individuals to whom it is addressed and may contain information that is privileged, confidential or exempt from other disclosure under applicable law. If you are not the intended recipient, you are notified that any disclosure, printing, copying, distribution or use of the contents is prohibited. If you have received this in error, please notify the sender immediately by telephone or by returning it by reply email and then permanently deleting the communicationfrom your system. Thank you. --- On Thu, 4/1/10, Erin Singleton <xxxxxx@xxxxxxxxxxxxxxxxxxxx> wrote: From: Erin Singleton <xxxxxx@xxxxxxxxxxxxxxxxxxxx> Subject: Device suggestions for ALS patient on Hospice and in Skilled To: xxxxxx@xxxxxxxxxxxxxxxxxxxx Date: Thursday, April 1, 2010, 1:36 PM Hello everyone!   I am new to the list serve and I'm hoping someone may be able to help with some suggestions for a patient of mine.   I have an ALS patient who in just 2 short weeks has declined significantly and her speech is no longer functional. She was in assisted living and this weekend was placed on hospice in skilled nursing. Her family really wants her to have some type of SGD but I know that the SNF/hospice is a problem for getting devices funded. I have not yet built up a loaner closet or else I would loan a device to her. I have provided them with ideas for low tech but they really want to try a device. At our last visit with each other she was able to use the Lightwriter and Dynawrite with her left hand with some success. I know a type-&-talk device is the direction she is leaning. Her daughter is asking to rent or borrow so that while she is on hospice she has some way to communicate.   If anyone has any suggestions I would so appreciate it!  Thanks.   Erin Singleton M.A., CCC-SLP Neuroscience Outpatient Rehabilitation Center 2335 East Kashian Lane, Suite 301 Fresno, California 93701 Office: (559) 459-6056 Cell: (559) 250-1949 Fax: (559) 459-2957 Email: xxxxxx@xxxxxxxxxxxxxxxxxxxx       ________________________________   ------------------------------------------------------- WARNING/CONFIDENTIAL: ------------------------------------------------------- This email, including attachments, may contain information that is privileged, confidential, and/or exempt from disclosure under applicable law (including, but not limited to, protected health information). It is not intended for transmission to, or receipt by, any unauthorized persons. If the reader of this message is not the intended recipient you are hereby notified that any dissemination, distribution or copying of this communication is strictly prohibited. If you believe this email was sent to you in error, do not read it. Reply to the sender informing them of the error and then destroy all copies and attachments of the message from your system. Thank you.

 

-------------------------------------------------------
WARNING/CONFIDENTIAL:
-------------------------------------------------------
This email, including attachments, may contain information that is privileged, confidential, and/or exempt from disclosure under applicable law (including, but not limited to, protected health information). It is not intended for transmission to, or receipt by, any unauthorized persons. If the reader of this message is not the intended recipient you are hereby notified that any dissemination, distribution or copying of this communication is strictly prohibited. If you believe this email was sent to you in error, do not read it. Reply to the sender informing them of the error and then destroy all copies and attachments of the message from your system. Thank you.