Pennsylvania Limitation PA/MA
(Penn Medicaid Department of Public Welfare)
- Diapers, Pull-ons,Liners:
combination CANNOT exceed 300 units every 31 days
- Large Disposable Underpads (Chux/Bedpads):
combination CANNOT exceed 60 units every 31 days
- Washable Bedpad/Chairpad: MSI901
combination CANNOT exceed 4 units every 31 days
(copay-$0.65 per washable bedpad/chairpad, for the 4 it’s $2.60. We mail-out a copayment bill once consumer reach %5.00 and Medicaid sent us an approval to send consumer a bill. Cons can call in and pay with credit or debit card, send money order or check.)
- Gloves:
combination CANNOT exceed 2 boxes every 31 days
(copay-$0.65 per box of gloves, per month, for the 2 boxes $1.30. We mail-out a copayment bill once consumer reach $5 and Medicaid sent us an approval to send consumer a bill. Cons can call in and pay with credit or debit card, send money order or check.)
Keystone First Community Healthchoices (511)
- Gloves
combination CANNOT exceed 5 boxes every 31 days
- Wipes & Barrier cream: OFFERED FOR PA CONS ONLY!!!
Covered under waiver. We would need a service from the care manager.
DELAWARE LIMITATIONS
(Diamond State Health Plan Plus) – 129
- Diapers, Pull-ons,liners, and small disposable bedpads (353)
combination CANNOT exceed 240 units every 31 days
can only get small disposable bedpads, NO large chux is covered.
- Gloves: combination CANNOT exceed over 2 boxes every 31 days
Highmark Health Options Limitations MCO (219) and Amerihealth DE MCO (507)
- Diapers, Pull-ons,Liners:
combination CANNOT exceed over 240 units every 31 days
- Large disposable bedpads:
combination CANNOT exceed 100 units every 31 days
- Gloves -combination CANNOT exceed 2 boxes every 31 days
- NO COPAY FOR GLOVES FOR DELAWARE
- NO WASHABLE BEDPADS, WASHABLE CHAIRPADS
- NO WAIVER ITEMS COVERED
Insplan 219 and 507 can get – 41409, 41309, 26262, 43554, 43552, 43551
31684 ONLY for Insplan 219