Page 17 - Work Force May 2024

Important reminders about the Empire Plan HCAP Program
JUNE 2023
The Empire Plan
REPORTING ON
HOME CARE ADVOCACY PROGRAM
There’s no place like home, especially when you have health issues. But sometimes after being discharged from the hospital, you still need skilled nursing care at home. Or, you or a loved one have a medical condition that calls for having special supplies at home.
When you need skilled nursing care, home infusion therapy or durable medical equipment, The Empire Plan Home Care Advocacy Program (HCAP) can help provide you with the services and support you need.
For Empire Plan Enrollees and for their enrolled Dependents, COBRA Enrollees with their Empire Plan benefits and Young Adult Option Enrollees
The Empire Plan’s Home Care Advocacy Program (HCAP) provides coverage for home care services, durable medical equipment, and related medical supplies.
HCAP is part of the Empire Plan Medical/Surgical Program,
which is administered by
United Healthcare. As
soon as the provider prescribes home care services, durable medical equipment or medical supplies, call HCAP toll free
at 1-877-7-NYSHIP (1-877-769-7447). Press or say 1 for the Medical/ Surgical Program, then 3 for HCAP.
An HCAP representative can
help enrollees get covered services quickly with paid-in-full benefits (when using an HCAP-approved provider). The HCAP team will arrange or help arrange for care with approved providers in the area and for ongoing care we will send a letter of confirmation.
There are six main types of equipment and services covered under HCAP when they are medically necessary:
Durable Medical Equipment and Related Supplies covered under HCAP is medical equipment that is for repeated use (not a consumable or disposable item), is used primarily for a medical purpose, is appropriate for use in the home and is generally not useful to a person in the absence of a sickness or injury.
Examples of durable medical equipment that can be covered under HCAP include, but are not limited to, hospital beds, manual wheelchairs and power mobility devices, CPAP devices and accessories, nebulizers, and oxygen equipment.
Medical supplies covered under HCAP include diabetic supplies, ostomy supplies and supplies used with covered durable medical equipment, such as oxygen tubing
and oxygen masks. Call HCAP before receiving durable medical equipment or supplies.
Diabetic and Ostomy Supplies
covered under HCAP include glucometers, test strips,
lancets, ostomy baseplates and pouches. Supplies must be prescribed
by a physician and determined to be
medically necessary. For most diabetic
supplies, call the Empire Plan Diabetic Supplies Pharmacy at
1-800-321-0591. Insulin pump requests must go
through HCAP. For ostomy supplies, call Byram Healthcare Centers at 1-800-354-4054.
Skilled Nursing Services covered under HCAP includes nursing in
the home when nurses provide skilled care. Care must be ordered and supervised by a physician. HCAP does not provide custodial care, companionship, or assistance with daily living, including care or services provided by a home health aide.
Home Infusion Therapy Services
covered under HCAP includes, but is not limited to, the administration of drugs or nutritional therapies (prescribed and supervised by a physician) and administered in the home by a nurse.
Communication Devices covered under HCAP includes rental or purchased devices ordered or prescribed by a physician if a speech-language pathologist determines the patient is unable to communicate through typical means, including speech or writing.
Enteral Formulas covered under HCAP are nutritional replacements taken by mouth or through a feeding tube that provide basic nutrition
when food in its usual form is not appropriate or adequate to meet the individual’s nutritional needs.
HCAP covers nonprescription enteral formulas for home use when the doctor gives a written order that identifies medical necessity. Prescribed enteral formulas must be proven safe and effective for the diagnosis.
Following HCAP requirements saves enrollees time and money, as there are no claim forms to fill out and enrollees have no out-of-pocket expenses for approved, pre-certified covered services. Individuals must call HCAP and set up use of network providers prior to receiving paid-in- full benefits.
Empire Plan enrollees and dependents in need of HCAP services should call the Empire Plan toll free
at 1-877-7-NYSHIP (1-877-769-7447) and press or say 1 for the Medical Surgical Program, administered by United Healthcare, then 3 for HCAP. Individuals can call HCAP from anywhere in the United States and representatives are available Monday through Friday 8:00 a.m. to 4:30 p.m. Eastern time. HCAP voicemail is available 24 hours a day, seven days a week so individuals can leave a message at any time.
In an emergency, get the care
or equipment/supplies needed right away, then call HCAP within 48 hours or as soon as possible. If HCAP determines that the urgent or emergency services were medically necessary, covered services and items will be certified. If it is after business hours, leave a message for an HCAP representative.
May 2024
The Work Force 17