Administrative Rules of Montana › Department 37 - PUBLIC HEALTH AND HUMAN SERVICES › Chapter 37.86 - MEDICAID PRIMARY CARE SERVICES › Subchapter 37.86.18 - Prosthetic Devices, Durable Medical Equipment, and Medical Supplies › Rule 37.86.1802 - PROSTHETIC DEVICES, DURABLE MEDICAL EQUIPMENT, AND MEDICAL SUPPLIES, GENERAL REQUIREMENTS

Current through Register Vol. 13, July 5, 2024
(1) These
				requirements are in addition to those contained in rule provisions generally
				applicable to Medicaid providers. Requirements for prosthetic devices, durable
				medical equipment, and medical supplies utilized by nursing facility residents
				are contained in the department's rules governing nursing facility
				reimbursement when the nursing facility bills for separately billable items as
				a skilled nursing durable medical equipment provider as outlined in ARM
				37.40.330.
(2) Reimbursement for prosthetic
				devices, durable medical equipment, and medical supplies will be limited to
				items included on the department's fee schedule delivered in the most
				appropriate and cost effective manner. Montana Medicaid adopts Medicare
				coverage criteria for Medicare covered durable medical equipment as outlined in
				the Region D Supplier Manual, local coverage determinations (LCDs) and national
				coverage determinations (NCDs) and as provided in ARM
				37.85.105(3).
				For prosthetic devices, durable medical equipment, and medical supplies not
				covered by Medicare, coverage will be determined by the department and
				published on the department's fee schedule in accordance with ARM
				37.86.1807.
				The items must be medically necessary and prescribed in accordance with (2)(a)
				by a physician or other licensed practitioner of the healing arts within the
				scope of his practice as defined by state law.
(a) A prescription or order must include the
				member's name or Medicaid identification number; order date; general
				description of the item or HCPCS code or HCPCS code narrative, or a brand name
				and model number; quantity to be dispensed, if applicable; treating
				practitioner's name or national provider identifier; and treating
				practitioner's signature. The original prescription must be retained in
				accordance with the requirements of ARM
				37.85.414.
				Prescriptions may be transmitted by an authorized provider to the durable
				medical equipment provider by electronic means or pursuant to an oral
				prescription made by an individual practitioner and promptly reduced to hard
				copy by the durable medical equipment provider containing all information
				required. Prescriptions for durable medical equipment, prosthetics, and
				orthotics (DMEPOS) must follow the Medicare criteria outlined in chapters 3 and
				4 of the Region D Medicare Supplier Manual as provided in ARM
				37.85.105(3).
				A copy of the Region D Medicare Supplier Manual may be obtained from the
				Department of Public Health and Human Services, Health Resources Division, 1401
				East Lockey, P.O. Box 202951, Helena, MT 59620-2951. For items requiring prior
				authorization the provider must include a copy of the prescription when
				submitting the prior authorization request.
(i) Prescriptions for oxygen must include the
				liter flow per minute, the hours of use per day, and the person's PO2 or oxygen
				saturation blood test(s) results.
(ii) If applicable, an order for durable
				medical equipment must list separately all concurrently ordered options,
				accessories, or additional features that are separately billed or require an
				upgrade code.
(iii) If applicable,
				an order for medical supplies must include all concurrently ordered supplies
				that are separately billed, listing each separately.