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.
Step 1 - Intake Form Completion
Step 2 - Therapist Evaluation
In order to determine what types of DME would benefit you or the person, you must consult with a therapist (OT, PT, SLP, BCBA). Ability Unlimited can assist you with finding professionals to complete the evaluation and provide sample evaluations for DME. 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.
For guidance on who should write the request, please see the table below.
|Examples of Assistive Technology Devices (not a comprehensive list)||Professional Evaluation Required|
|Organizational Devices||Occupational Therapist, Psychologist, or Psychiatrist|
|Computer Software or Communication Device||Speech Language Pathologist or Occupational Therapist|
|Orthotics, such as Braces for Hands, Arms, Feet, Legs, etc.||Physical Therapist, Physician, or Orthotist|
|Writing Orthotics||Occupational Therapist or Speech Language Pathologist|
|Support Chairs||Physical Therapist or Occupational Therapist|
|Specialized Toilets||Occupational Therapist or Physical Therapist|
|Other Specialized Devices/Equipment||Physician, Speech Language Pathologist, Behavioral Consultant, Psychologist,
Psychiatrist, Physical Therapist or Occupational Therapist, depending on the Device or Equipment
|Specially Designed Utensils for Eating||Occupational Therapist or Speech Language Pathologist|
|Weighted Blankets or Vests||Physical Therapist, Occupational Therapist, Psychologist, or Behavioral Consultant|
The following guidelines set in place by DMAS must be included. All of the following items 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 your therapist has sent us the written evaluation for the recommended AT, Ability Unlimited will submit a request for your doctor to complete a Certificate of Medical Necessity (DMAS-352). We will also request that your doctor review the therapist’s evaluation and sign/date the evaluation below the therapist’s signature.
Prior to submitting the DME request, our team will review all documents once 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.
- If you are a CCC Plus Waiver recipient, the request is sent to your respective MCO.
- If you are Medicaid Fee For Service (EPSDT/HIPP), the request is sent to DMAS.
- If you are a DD Waiver recipient (BI/CL/FIS), the request is sent to DBHDS.
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.