Question #1: I am a current recipient of Home and Residential Health Care (HRHC) and/or need to renew my current Durable Medical Equipment (DME) under EEOICPA. I do not want to leave my house to see my doctor because of COVID-19 and I don’t want to lose my home health care. Am I required to have a face-to-face appointment with my physician to maintain my previously authorized level of care?
Answer #1: During this temporary period of heightened concern regarding exposures to high risk populations, DEEOIC will be reviewing the circumstances of each request to continue HRHC or DME at the current authorized level on a case-by-case basis. If a physician is unable to see a claimant face-to-face for medical reasons, we expect your treating physician to include that rationale in their letter of medical necessity (LMN) when requesting renewal. Additionally, any LMN should continue to include a well rationalized and medically supported medical opinion of why the current level of care continues to be appropriate.
Question #2: I am requesting new or increased levels of Home and Residential Health Care (HRHC) and/or Durable Medical Equipment (DME) under EEOICPA. I do not want to leave my house to see my doctor because of COVID-19. Am I required to have a face-to-face appointment with my physician for either initial requests for HRHC/DME or requests for increased levels of previously authorized care? Can I use telemedicine in place of face-to-face examinations for HRHC and DME evaluations?
Answer #2: DEEOIC requires face-to-face examinations for new or increased levels of HRHC or DME, but during the COVID-19 pandemic the definition of face-to-face examinations has been temporarily broadened. Due to state and local government pandemic restrictions imposed to limit interpersonal contact, DEEOIC is temporarily permitting Medical Benefit Examiner (MBE) staff to accept a Letter of Medical Necessity (LMN) that a physician prepared using information collected from an alternative method of patient evaluation (telemedicine). This will occur only under those circumstances where the physician has the legal or licensing authority to conduct such an examination. For more information regarding Telemedicine for HRHC and DME, please see Bulletin 22-03.
Question #3: My physician has offered the option of using telemedicine for routine medical appointments. Will DEEOIC issue payment and authorize prescribed treatments for accepted conditions via telemedicine?
Answer #3: Yes, during this period of heightened concern regarding exposures to high-risk populations, DEEOIC recognizes the need to implement temporary procedures to allow for the use of telemedicine in place of routine medical appointments. If permitted by their respective legal or licensing authority, a physician can choose to conduct a routine medical appointment through telemedicine (e.g., phone, video conferencing, or similar technologies) when the physician believes it is in the best interest of the patient. Physicians may bill DEEOIC without preauthorization using appropriate telemedicine billing codes. For more information regarding telemedicine for routine physician appointments, as well as physician responsibilities, please see Circular 22-01.
Question #4: I have filed a claim with DEEOIC, and they are requesting information within 30 days, but I am unable to see or talk to my doctor. Is there any flexibility on the timeframe?
Answer #4: Yes, DEEOIC will be flexible regarding timeframes for medical evidence on a case-by-case basis if the COVID-19 pandemic prevents you from obtaining the requested information.
Question #5: Do you require claimants to have in-person hearings?
Answer #5: No, DEEOIC has both WebEx and telephone hearings available.
Question #6: I have a claim with the DEEOIC which has been recommended for denial and they tell me that I have 60 days to appeal, but I don’t want to leave my house to obtain additional evidence because of COVID-19. Are there any flexibilities on this deadline?
Answer #6: No, because that is a regulatory deadline; however, if you have new evidence to submit at any time after a final decision, you may submit it and the DEEOIC Director may reopen your claim for review.
Question #7: I have to refill my prescription but do not want to risk exposure to the COVID-19. Are there any other options?
Answer #7: Yes, many pharmacies have mail order and delivery options.
Question #8: If I have non-case specific questions regarding DEEOIC’s handling of COVID-19, where do I turn?
Answer #8: You can submit any question via our public email box at firstname.lastname@example.org. DEEOIC has staff dedicated to reviewing this email box and will ensure that questions related to COVID-19 are given top priority for a rapid response.