Information for ALFs on Coverage Criteria for Auto-Retractable Safety Lancets

In consultation with Department of Medical Assistance Services (DMAS) staff, the Department of Social Services (DSS) provided the following guidance to assisted living facilities related to Medicaid coverage criteria for the auto-retractable safety lancets.

All Medicaid recipients residing in assisted living facilities (ALF) should have their own supplies ordered through a durable medical equipment (DME) company as they would if living at home.  If an ALF is assisting the resident to obtain supplies and wants to use the same DME company for all their recipients, that is permissible so long as the resident has no objections.  However, each recipient should have his own supplies based on his individual needs.

The ALF should let the DME company know what supplies and quantities are needed based on frequency of use.  As an example, the ALF should notify the DME that the recipient’s blood sugar is tested 4 x per day.  The DME provider can then take into account the frequency of testing and determine how many lancets will be supplied per month.

The DME company will need to get a certificate of medical necessity (CMN) which the doctor will sign.  The DME company should know how to take care of all of the paper work and documentation requirements.

If the recipient has a primary insurance, the DME is required to bill the primary insurance first.  If the primary insurance does not cover an item but Medicaid does (in this case single use lancets) the DME company will then bill Medicaid.  If the DME company is not sure how to do this or has questions they can contact DMAS.

In the case of Medicare recipients, since Medicare does not currently cover single use lancets, the DME provider does not have to bill Medicare for the denial; they can attached a short letter to the claim stating they know this item is non-covered by Medicare.

Members requiring additional assistance with this process should contact one of the following DMAS staff:

  • Elizabeth Flaherty, RN, Healthcare Compliance Specialist II, Long-Term Care Division at 804-786-7953
  • Barbara Seymour, Healthcare Compliance Specialist II, Long-Term Care Division at 804-786-1835

For private pay residents, DSS has also acknowledged that several of the distribution companies that were providing auto-retractable safety lancets to private pay individuals  had exhausted their supplies, raised prices significantly in response to increasing demand or simply no longer market directly to consumers.   Families in one locality did the research to locate a supplier who had adequate/acceptable stock and good prices.  While DSS is not endorsing this, or any other specific provider, they are supplying the company information for individuals and/or facilities that may wish to follow-up for themselves:

Diabetic Health and Wellness

DSS hopes this information will help alleviate the difficulties some providers have experienced in transitioning to the latest infection control safety guidelines on fingerstick devices for blood glucose monitoring.