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Next Steps - Durable Medical Equipment

Once you are Medicaid eligible, Ability Unlimited can assist you with obtaining your necessary Durable Medical Equipment (DME) through Medicaid funding or Private Pay. In order to proceed with a request for DME through Ability Unlimited, you will need to complete a Provider Choice form, Release of Information form, and DME Intake form.

Durable Medical Equipment

Watch the video below to learn more about the Durable Medical Equipment that Ability Unlimited can assist with through Medicaid funding or Private Pay:

Intake Process

Step 1 - Intake Form Completion

You have the option to complete the necessary forms online or manually on paper.

Step 2 - Evaluation

In order to determine what types of DME would benefit you or the person, you may have to consult with a professional (OT, PT, SLP, BCBA) specific to the type of DME being requested. In some cases, DME will require a written prescription from a primary care physician to begin the process. Ability Unlimited can assist you with finding professionals to complete the evaluation and provide sample evaluations for DME. For example, a wheelchair request would need a seating and mobility consultation, a stander would need a PT consultation, etc. Proving medical necessity for a device or equipment is imperative.

Please note: Ability Unlimited does not suggest the types of devices/accessories for anyone; these recommendations must come from a professional who is familiar with the patient’s needs and the device/s being recommended.

The following guidelines set in place by DMAS for DME requests must be included in the written referral:

  • Details of the device(s) or app(s) that will benefit the person’s medical need.
    • Include the device(s) or app(s) make and model or specifics.
    • Include cases if a need for them has been discussed.
  • In detail, describe other alternatives tried or explored, as well as their success or failure.
  • List any therapeutic interventions tried or ongoing.
  • In detail, describe how the DME will benefit the person’s medical need and whether it’s the best option for treatment.
  • Describe the person’s functional limitation (need for help in ADL’s/IADL’s).
    • Include the relationship to the requested DME and how it will improve functional need.
  • Describe any treatment used in conjunction with the device(s) or app(s).
  • Describe how the need was previously met. If not met, explain why and how the device will help meet medical needs.
  • Identify any changes that have occurred which necessitate the DME request.
  • Has the requested DME been trialed successfully? Describe the benefit and use.
    • It’s very important to explain why this DME device or app is medically justified over other less expensive devices or apps.
  • If the person has an IEP and uses the device in school, explain why this device would benefit them in the home environment as well.
    • If the IEP does not include this DME, have their school write a letter to explain why it’s not included.
  • Include any therapy notes, pictures, or medical history that are important in justifying the medical need.
  • Make sure your referral letter is signed and dated.

Step 3 - Documentation Review

Once we receive the written evaluation for the recommended DME, Ability Unlimited will review it and submit a request to your primary care physician to complete a Certificate of Medical Necessity (DMAS-352). We will also request that your PCP review the evaluation and sign/date the evaluation below the signature. Additionally, a review of the primary insurance DME coverage, and/or the state medical plan coverage will be done to verify if a Service Authorization is required. If it is required, Ability Unlimited will then request the Certificate of Medical Necessity (DMAS-352) from the PCP and submit for authorization, wait for approval, and then order and ship the items. If it is not required, Ability Unlimited will proceed with ordering and shipping the items.

Prior to submitting the DME request, our team will review all documents received to make sure that the request for DME is clinically aligned with DMAS regulations.

Step 4 - Submitting the Request

Once our team has determined that your DME request is ready to submit, we will send it to the authorized agency for review.

There can be a 30 to 90 day turnaround time for approval. It is possible that we will need to request more information from you, your doctor, or your therapist if the agency requires it during the review process.

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