Chapter 14 Durable Medical Equipment (DME)

Durable Medical Equipment (DME)• Suppliers providing motorized/power wheelchairs to recipients must have at leastone employee with certification from Rehabilitation Engineering and assistiveTechnology Society of North America (RESNA) or registered with the NationalRegistry of Rehab Technology Suppliers (NRRTS). After October 1, 2004,suppliers must meet these certification requirements to providemotorized/power wheelchairs.For information regarding certification through RESNA contact: Ms. TonyaVaughn at (703) 524-6686, extension 311.The following is the process for obtaining prior approval of amotorized/power wheelchair and accessories:• The attending physician must provide the patient with a prescription for themotorized/power wheelchair.• The attending physician must provide medical documentation that describes themedical reason(s) why a motorized/power wheelchair is medically necessary. Themedical documentation should also include diagnoses, assessment of medicalneeds, and a plan of care.• The patient must choose a Durable Medical Equipment (DME) provider that willprovide the wheelchair.• The DME provider should arrange to have the Alabama Medicaid AgencyMotorized/Power Wheelchair Assessment Form 384 completed by an Alabamalicensed physical therapist who is employed by a Medicaid enrolled hospitaloutpatient department. The physical therapist’s evaluation is paid separatelyand is not the responsibility of the DME provider.• The DME provider must ensure that the prior authorization request for themotorized/power wheelchair includes the product’s model number and name, thename of the manufacturer, and a list of all wheelchair accessories with applicableprocedure codes.The DME provider will complete the Alabama Medicaid Agency Prior AuthorizationForm 342 and submit Form 384 along with medical documentation from the physicianand mail to EDS, Prior Authorization Unit, P.O. Box 244032, Montgomery,Alabama 36124-4032.NOTE:Purchase of the wheelchair is limited to one every five years for recipients whomeet the above criteria.Low Pressure and Positioning Equalization Pad for Wheelchair (E0192)(K0108)To qualify for Medicaid reimbursement of a low pressure equalization pad, theequipment must be prescribed as medically necessary for the recipient by thephysician. Requests for coverage must be received by EDS within thirty calendardays after the date that the equipment was dispensed. To qualify for Medicaidreimbursement or a Low Pressure and Positioning Equalization Pad for a wheelchair,the recipient must meet the following documented conditions:• A licensed physician must prescribe the equipment as medically necessary.14-20 April 2005