Durable Medical Equipment (DME) is equipment such as wheelchairs, walkers or bath chairs and supplies such as feeding tubes, catheters and dressings. DME and supplies are usually not useful to a person who is not sick or injured.
Medicaid will purchase or rent, when medically necessary, reasonable, and cost effective, durable medical equipment (DME) and medical supplies for participants residing in community setting including those provided by qualified home health providers under home health agency plans of care that meet the requirements found in the state rules.
All requests require a prescription signed by a doctor, nurse practitioner, or physician assistant. No verbal orders or stamped signatures will be accepted. The medical necessity rationale for the item must be submitted. This supporting documentation can be a letter of medical necessity, physician notes, or therapy notes. Refer to the Provider Handbook, Supplies, to learn the criteria which is reviewed for the item being requested. If you view a Denial in the Molina HealthPAS portal, click on the Notes, which will explain the reason for the Denial. Or, ask the Molina Customer Service Representative to read you the Notes in the Denial, in order to understand the reason the item was not approved.
Urgent requests are given priority. An urgent request constitutes equipment the participant needs to discharge from a facility – for example, hospital, skilled nursing facility or rehabilitation facility.
You can refer to the Frequently Asked Questions document that may answer most of your DME questions. If you have further questions you can email our DME Representative.
For DME items that require a Prior Authorization you can fax your rquests to (877) 314-8782.