Important Notice on DME Recall

Philips Respironics issued a recall on almost all of their CPAP, BiPAP and vents last week.  They are instructing any patient using an affected CPAP or BiPAP device, to STOP using that machine immediately.  They are also instructing patients using an affected vent to only continue using it IF they have an inline bacteria filter.  

You can view the official recall page by Philips Respironics here.  You can also read DMAS' Frequently Asked Questions in English or Spanish.

There are still many unanswered questions from Philips Respironics about this recall, but DMAS is issuing formal guidance for fee-for-service (FFS) members. 

For individuals enrolled in FFS, DME providers must submit a service authorization request to replace patient-owned CPAP, BiPAP and ventilators that are affected by this recall.  

Instructions for FFS

1. DME providers can submit for service authorization for replacement of patient-owned devices through KePRO.
2. A Certificate of Medical Necessity (CMN) will not be required at the time of service authorization to streamline the process of getting new CPAP, BiPAP and ventilators out to individuals in need.  However, the DME provider must attest that the member is actively using the device and that the device is patient-owned (meaning previously purchased by Virginia Medicaid or another carrier).
3. A CMN must be completed and in the member's file within 60 days of receipt of the new device.  This is subject to review on post payment audit.
4. If it is determined that Philips Respironics will reimburse funds toward recalled devices, those funds will need to be returned to DMAS.  DMAS will post additional instructions on how to return funds if this is the case.

For FFS members, providers can send questions to the DME email at
dme@dmas.virginia.gov.

DMAS will continue to monitor this situation closely and give additional guidance as more details are made available from Philips Respironics about the recall.

Instructions for Managed Care

Members who are enrolled in an MCO should contact the individual plan to determine their process for handling this recall. See below for more details: 

• Optima- Will follow DMAS guidance. Contact Member/Providers Services or 757-552-8370 for questions.  
• Aetna- Will follow DMAS guidance. Information will be posted to the website. Provider portal (Availity):
  https://www.aetnabetterhealth.com/virginia/providers/authorizations 
  Fax: 1-866-669-2454 Phone: 1-800-279-1878.
• Magellan- Will have a streamlined process.  Reach out to PR reps or 724-882-3622 for questions.
• VA Premier- Will follow DMAS guidance.  Care coordinators will reach out to members and providers. Call 877-719-735 for questions
• United Health Care- Is actively reaching out to members and providers.  Contact 1-844-284-0146 (Medallion) or 1-877-843-4366 (CCC Plus) for questions to initiate a request.
• Anthem- Will have guidance posted to the website and will be emailing providers.  Medallion Provider Services at 800-901-0020 or Anthem CCC Plus Provider Services at 855-323-4687.