For those who might benefit from this information, here is updated information on coverage of incontinence briefs (adult diapers) for those in the Arizona Long Term Care System (ALTCS) who are 21+ years of age.
Incontinence briefs (adult diapers and pull-ups) are covered for members on Arizona Health Care Cost Containment System (AHCCCS) when necessary to treat a medical condition. Prior authorization may be required under these circumstances.
Beginning December 15, 2014, AHCCCS has expanded coverage of incontinence briefs for members in the ALTCS program who are 21 years and older. Members in the ALTCS program who are 21 years and older can also receive incontinence briefs for preventative purposes when all of the following conditions are met:
A. The member is incontinent due to a documented medical condition that causes incontinence of bowel and/or bladder,
B. The PCP or attending physician has issued a prescription ordering the incontinence briefs,
C. Incontinence briefs do not exceed 180 briefs per month unless the prescribing physician presents evidence of medical necessity for more than 180 briefs per month,
D. The member obtains incontinence briefs from vendors within the Contractor’s network, AND
E. Prior authorization has been obtained if required by the Administration, Contractor, or Contractor’s designee, as appropriate. Contractors shall not require a new prior authorization to be issued more frequently than every twelve months.
AHCCCS also covers incontinence briefs for preventative purposes for members under the age of 21. Refer to the links below for more information as outlined in AHCCCS policy 310-P, AHCCCS policy 430, and AHCCCS rule R9-22-212.