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Medicaid Update: Transmittal 15-38 Payments for Durable Medical Equipment (DME)


Friday, October 9, 2015

The purpose oft his transmittal is to clarify the Department of Health Care Finance's policies regarding reimbursement for certain items of Durable Medical Equipment (DME), Prosthetics, Orthotics and Supplies for people who are residing in an ICFIIID, the steps DHCF has taken to ensure that claims are paid in accordance with policy and to provide guidance to DME suppliers and ICFIIID operators regarding the procedures to be used should a claim be denied that should have been paid by DHCF. Under 29 DCMR 4100.7(f), the rates paid to ICFIIIDs do not include durable medical equipment, prosthetic, orthotic, and supply items that either require prior authorization or are solely for the use of one (1) person (such as a wheelchair). This provision is intended to ensure that DHCF and not the ICFIIID, pays for customized items and items that cost more than $500 that are not routinely supplied by an ICFIIID.