Apnea Monitors

Apnea Monitors A. Medicaid defines an apnea monitor as a device used to monitor respiratory movements. This may be accomplished by use of an apnea alarm mattress or by use of alarm sensitive devices to measure thoracic and abdominal movement and heart rate. B. Medicaid covers apnea monitors for all beneficiaries: 1. When prior authorized by the Utilization Management and Quality Improvement Organization (UM/QIO), the Division of Medicaid or designated entity. 2. For an initial three (3) month rental trial period, then recertification is required. The three (3) month rental trial period applies toward the maximum reimbursement for purchase. 3. [Reserved] 4. When the beneficiary is/had at least one (1) of the following: a) An infant who has a diagnosis of apnea of prematurity. b) A preterm infant with continued symptomatic apnea past thirty-six (36) weeks gestational age. c) Been observed having or has a recorded episode of prolonged apnea within the last three (3) months that is documented by medical personnel and associated with bradycardia, reflux, cyanosis, or pallor. Medicaid defines prolonged apnea as cessation of breathing greater than twenty (20) seconds or bradycardia episodes less than sixty (60) beats per minute (bpm) for greater than five (5) seconds. d) An infant who is a sibling of a child with sudden infant death syndrome (SIDS), or has two (2) siblings with a diagnosis of apnea. e) Had an event or events requiring vigorous stimulation or resuscitation within the past three (3) months. f) A tracheotomy. g) An infant with bronchopulmonary dysplasia who requires oxygen and displays medical instability. h) An adult or child has demonstrated symptomatic apnea due to neurological impairment, craniofacial malformation, central hyperventilation syndrome, or is secondary to gastrointestinal reflux C. Medicaid will cover diagnoses not included above on an individual basis with appropriate documentation. D. Medicaid does not cover apnea monitors for terminally ill beneficiaries or for those who have "do not resuscitate" orders. E. Medicaid covers apnea monitors for an initial three (3) month certification. After the three (3) month initial certification, apnea monitors may be recertified up to seven (7) additional months with a new prescription or letter of medical necessity. 1. Medicaid will not reimburse for a three (3) month trial period then pay full purchase price. 2. Medicaid does not cover supplies, such as a battery pack, safety lead wires, electrodes, electrode belts, event recording downloads, or remote alarms separately. 3. Medicaid requires that apnea monitors must be returned to the DME provider after it is no longer required if the rental period is less than ten (10) months.