MEDICAL SERVICES

600 E Boulevard Ave Dept 325 | Bismarck ND 58505-0250

701.328.7068 | Fax 701.328.1544 | 800.755.2604 | 711 (TTY) | Provider Relations 701.328.7098 | www.nd.gov/dhs

The 2019 DME manual was a collaboration project between the Midwest Association for Medical Equipment Services & Supplies (MAMES) and the Department over a time frame of eight months. The MAMES group asked the Department to review the manual and the current DME policy format due the extension revisions made to the DME manual. They would submit their feedback on areas that they felt needed clarification, possible changes and their overall impression of the manual. Provider feedback was very positive. Providers found the manual to be well organized and addressed DME adequately. Suggestions for areas of additional clarification were taken into consideration and addressed in the final version. The providers were especially pleased with the DME policy format and found it to be a very informative, user friendly tool that lists coverage criteria, required documents, and identified dates of policy changes. They requested that the Department continue to use the current DME policy format and that the policies remain independent of the DME manual. The providers also requested that policies be listed on the DME webpage for easy, quick access. The following is the MAMES groups survey results with questions on the manual and the Department’s responses.

MAMES Survey on Medicaid Manual

Do you like how the manual is organized? 6 responses

Yes

No

Please rate how well the manual provides answers to your questions on ND Medicaid coverage of DMEPOS (check the box): 6 responses

Poor 0 (0%)

Fair 0 (0%)

Excellent 0 (0%)

0 2 3 4 5 6

Please provide feedback on your rating above: 1. Well organized.

2. The manual seems to cover the basics of DME. Would be helpful if it provided policy specific to

CRT policy. Example is repairs to CRT equipment is treated same a DME?

Sent for clarification. See question 2 below for provider’s response and North Dakota Medicaid response.

Please provide comments/feedback on any policy/policies that you feel needs to be changed or made clearer: 3 company responses

1. Policy on contacting the member within 5 days. Medicare allows 10 tens, not sure why NDMA is

more restrictive.

North Dakota Medicaid Response: Section will be revised to state you may contact member(s) no sooner than 14 calendar days prior to the delivery/shipping date 14 days to mirror Medicare policy.

2. Prescription requirements for member owned custom mobility equipment that is lifetime need. Would like to have conversation on modifying the PRESCRIPTION requirement that provides the program with necessary oversight but allows recipient a quicker turnaround on repair.

Provider please clarify on this statement as North Dakota Medicaid does not require a prescription on equipment that requires repair. A prescription is needed if the equipment is no longer meeting the member’s functional need or it cannot be repaired or not able to be modified to meet functional need. If not repairable or modifiable then a practitioner visit and new order is needed.

DME Provider Response: Reached out to the provider who submitted this question. He did not respond to Kevin’s request.

North Dakota Medicaid Response: Later Tim from Numotion emailed his clarification. A Prescription is needed only when the member has no history of a w/c or the wheelchair is no longer meeting their medical needs due to a change in condition. Shared that another DME provider gets a prescription for repairs to member’s equipment and keeps in member’s file as a prescription is good for a year and has in case of audit, they feel they are covered. He thought they may do so too as maybe easier as they are used to obtaining a prescription.

3. Non-covered policy list does not allow ability to submit for denial and tertiary payers like waiver

programs require denials. North Dakota Medicaid Response: The Department reviewed the submitted claim examples and will be making updates to the MMIS as all non-covered items should being denied with “PR” denial code “patient responsibility" instead of a “CO” denial code “contractual obligation”.

4. Payment methodology for manually priced codes is at a cost plus methodology. This methodology does not account for providers operational cost and creates payment inequities for larger providers. Would kindly request an opportunity to discuss the merits of a MSRP less methodology

North Dakota Medicaid Response: This request is not related to the policy coverage of the DME Manual.

5. Would like clarification on a gait trainer as non-covered if member has a standing frame.

North Dakota Medicaid Response: If a member can ambulate in a gait trainer, a stander is not warranted as stander policy states it is covered if a member is unable to stand without the aid of adaptive equipment, or effective weight bearing cannot be achieved by any other means, or member is unable to stand or ambulate due to long term medical conditions and ambulation will most likely not occur.

6. Page 10

All records shall be maintained in hard copy for at least seven years after the date of service or as required by rule. Upon reasonable request, the Department, the US Department of Health and the Human Services (DHHS) or their agencies, shall be given immediate access to, and permitted to review and copy all records relied on by the DMEPOS provider in support of services billed to Medicaid. Copies will be furnished at the provider's expense. The provider agrees to follow all applicable state and federal laws and regulations related to maintaining confidentiality of records.

DME Provider Response: Many providers use digital copies of documentation. This seems to indicate the need for paper records.

North Dakota Medicaid Response: The medical record must be in its original or legally reproduced form, which maybe electronic, so that the medical records may be reviewed and audited by authorized entities. Will revise the section and add the Medical Records Retention and Media Formats link.

7. Page 10

North Dakota Medicaid accepts a physician (MD/D0/DPM}, certified nurse practitioner (NP}, physician assistant (PA), or a Clinical Nurse Specialist (CNS) signatures, within the scope of their practice as defined by state law. Hereinafter will be referred to as "practitioner".

DME Provider Response: Can you please clarify?

North Dakota Medicaid Response: Provider please be specific to what needs clarifying as not sure what you are asking?

DME Provider Response: “Please remove this request and or supplier comment.”

8. Page 11

Throughout any rental period or continuous supply, there must be an active practitioner's order for ongoing use, the service authorization (if required) effective dates are still applicable, and there is a continued medical need for the item. The DMEPOS provider must contact the member or their representative within five (5) calendar days prior to each billing cycle to verify the rented item is still medically necessary, in working condition and being used by the member (contact does not include system generated correspondence}. Verification must be documented and maintained in the DMEPOS provider's records and be accessible for audits.

DME Provider Response: Please explain what is meant by "system generated correspondence"?

North Dakota Medicaid Response: A “system generated correspondence” means automated update letters or emails where there is not active interaction with the member or their representative.

9. Page 14

DMEPOS Providers may deliver item(s} directly to the member or the designee (person authorized to sign and accept delivery on behalf of the member). The relationship of the designee to the member should be noted on the delivery slip obtained by the provider (i.e., spouse, neighbor).The signature of the designee must be legible. If the signature of the designee is not legible, the provider/shipping service should note the name of the designee on the delivery slip.

DME Provider Response: Suppliers request that ND Medical Assistance follow the Medicare Guidelines regarding Proof of Delivery. The process is listed below:

Method 2 - Delivery via Shipping or Delivery Service Directly to a Beneficiary

If the supplier uses a shipping service or mail order, the POD documentation must be a complete record tracking the item(s) from the DMEPOS supplier to the beneficiary. An example of acceptable POD would include both the supplier's own detailed shipping invoice and the delivery service's tracking information. The supplier's record must be linked to the delivery service record by some clear method like the delivery service's package identification number or supplier's invoice number for the package sent to the beneficiary. The POD document must include: • Beneficiary's name • Delivery address • Delivery service's package identification number, supplier invoice number, or alternative method that links supplier's delivery documents with delivery service's records

• A description of item(s) being delivered. Description can be a narrative description (e.g., lightweight wheelchair base), a HCPCS code, the long description of a HCPCS code, or a brand name/model number

• Quantity delivered • Date delivered • Evidence of delivery

North Dakota Medicaid Response: Provider please elaborate why Method two as Medicare has three.

DME Provider Response: Barb Stockert email response: After Kevin’s discussion with you it is probably best to pull these comments. Leave the delivery requirements as listed.

10. Page 6

"The Department is committed to paying Medicaid provider claims as quickly as possible."

DME Provider Response: suggest to please review Medicare LCD on Clean Claims Payment. The difference in payment floors is further incentive for suppliers to consider use of electronic claims submission to improve their cash flow, record keeping, and claim status tracking ability. Suppliers suggest a timeline in writing be set by the state for clean claims payment.

A "clean" claim is one that does not require investigation or development outside the DME MAC operation on a prepayment basis.

The Medicare statute provides for claims payment ''floors" and "ceilings." A floor is the minimum amount of time a claim must be held before payment can be released. A ceiling is the maximum time allowed for processing a "clean" claim before Medicare owes interest to a supplier of services. Suppliers who file paper claims will not be paid before the 2gth day after the date of receipt of their claims, i.e., a 28-day payment floor. However, clean claims filed electronically can be paid as early as 14 days after receipt, i.e., a 13-day payment floor. Interest payments will begin on the 31st day after the date of receipt for clean electronic and paper claims that are not yet paid.

North Dakota Medicaid Response: Will remove the above comment from the DME manual as is a claims processing issue.

11. Page 7

"The date of service that the procedure is rendered/delivered is the date of service on the claim (excludes supplies with grace period)."

DME Provider Response: Specific to supplies: Currently, if supplies are provided with overlapping dates the claim will deny. The supplier has to take time to work the denial to get it processed correctly. If this is the policy, the system should be fixed so the overlapping (grace period) of supplies should process appropriately without denying. North Dakota Medicaid Response: Recommend that providers work with the claims staff to insure they are submitting the monthly span dates correctly as dates cannot overlap. For audit purposes, providers cannot utilize the 5 day earlier request every month as this would appear as 13 months being dispensed instead of the allowed 12 months which a prescription is only valid for.

12. Page 10

"All medical record entries must be legible and complete, dated and timed,

DME Provider Response: Not all medical record entries are "timed." Suggest for "timed" to be removed.

All records shall be maintained in hard copy for at least seven years after the date of service or as required by rule. Upon reasonable request, the Department, the US Department of Health and the Human Services (DHHS) or their agencies, shall be given immediate access to, and permitted to review and copy all records relied on by the DMEPOS provider in support of services billed to Medicaid. Copies will be furnished at the provider's expense. The provider agrees to follow all applicable state and federal laws and regulations related to maintaining confidentiality of records.

DME Provider Response: Suggest for the state to allow documents (in their original format, without alteration) to be stored in an approved/licensed Electronic Health Record Retention System.

North Dakota Medicaid Response: Will remove “timed”. In the case of an audit and/or questions regarding authentication the supplier would be required and responsible to validate the document(s).

13. Page 11 "Documentation supporting that the member or member's caregiver was provided with manufacturer instructions, warranty information, service manual and operating instructions. " Suppliers suggest changing to "and/or". For some items these documents may be the same. North Dakota Medicaid Response: Provider please clarify where the “and/or” is to be placed. DME Provider Response: phoned and said they would like it to be between service manual and/or operating instructions. North Dakota Medicaid Response: Will revise as requested as long as the provider indicates which was provided to the member.

14. Page 11 & 17

"Rental pick up documentation requirements DME Provider Response: suggest please review Medicare's requirement for a pickup ticket. Medicare: For purposes of this section, a pick-up slip is written confirmation, provided by a supplier, that the supplier has removed an item of DME from the beneficiary's home. When making determinations, DME MAGs, Zone Program Integrity Contractors (ZP/Cs) and Unified Program Integrity Contractors (UPICs) must determine whether equipment is present in the home and which equipment is being used by the beneficiary. It is inappropriate to determine, solely based on lack of a pick-up slip, that a piece of equipment may still be in use. It is also inappropriate for OME MAGs, UPICs and ZPICs to deny claims solely based on lack of a pick-up slip. These claims should be developed to determine which piece of equipment is medically necessary. DME Provider Response: suggest that Medicare's requirement be followed. Client name and address, Description of item, product name and/or model serial number, date picked up, and signature of staff should be sufficient. Listing the ND Medicaid number, where the item was picked up, and or meter/hour readings should not be required. Many suppliers have removed health Information from their invoices. North Dakota Medicaid Response: Will remove from the list ND Medicaid number and meter/hour readings. Where the item is picked up will remain as needed to support item was being used in appropriate place of service.

15. Page 11 & 16

Throughout any rental period or continuous supply, there must be an active practitioner's order for ongoing use, the service authorization (if required) effective dates are still applicable, and there is a continued medical need for the item. The DMEPOS provider must contact the member or their representative within five (5) calendar days prior to each billing cycle to verify the rented item is still medically necessary, in working condition and being used by the member (contact does not include system generated correspondence). Verification must be documented and maintained in the DMEPOS provider's records and be accessible for audits. DME Provider Response: suggest the Medicare requirement listed below on Continued Use and Refill Requirements be followed. To require suppliers to contact every client 5 days prior to each month’s billing is truly not realistic or doable.

North Dakota Medicaid Response: Section will be revised to may contact member(s) no sooner than 14 calendar days prior to the delivery/shipping date 14 days to mirror Medicare. Medicare: Continued use describes the ongoing utilization of supplies or rented item by a beneficiary. Suppliers are responsible for monitoring utilization of DMEPOS rental items and supplies. No monitoring of purchase items or capped rental items that have converted to a purchase is required. Suppliers must discontinue billing Medicare when rental items or ongoing supply items are no longer being used by the beneficiary. Beneficiary medical records or supplier records may be used to confirm that a DMEPOS item continues to be used by the beneficiary. Any of the following may serve as documentation that an item submitted for reimbursement continues to be used by the beneficiary: -Timely documentation in the beneficiary's medical record showing usage of the item, related options/accessories and supplies -Supplier records documenting the request for refill/replacement of supplies in compliance with the refill documentation requirements section. This is deemed sufficient to document continued use for the base item as well. -Supplier records documenting beneficiary confirmation of continued use of rental item. -Timely documentation is defined as a record in the preceding 12 months unless otherwise specified elsewhere in this policy. Refill Requirements For all DMEPOS items and supplies provided on a recurring basis, billing must be based on prospective, not retrospective use. For DMEPOS products that are supplied as refills to the original order, suppliers must contact the beneficiary prior to dispensing the refill and not automatically ship on a pre-determined basis, even if authorized by the beneficiary. This shall be done to ensure that the refilled item remains reasonable and necessary, existing supplies are approaching exhaustion, and to confirm any changes or modifications to the order. Contact with the beneficiary or designee regarding refills must take place no sooner than 14 calendar days prior to the delivery/shipping date. For delivery of refills, the supplier must deliver the DMEPOS product no sooner than 10 calendar days prior to the end of usage for the current product. This is regardless of which delivery method is utilized. For all DMEPOS items that are provided on a recurring basis, suppliers are required to have contact with the beneficiary or caregiver/designee prior to dispensing a new supply of items. Suppliers must not deliver refills without a refill request from a beneficiary. Items delivered without a valid, documented refill request will be denied as not reasonable and necessary. Suppliers must not dispense a quantity of supplies exceeding a beneficiary's expected utilization. Suppliers must stay attuned to changed or atypical utilization patterns on the part of their clients. Suppliers must verify with the ordering physicians that any changed or atypical utilization is warranted. Regardless of utilization, a supplier must not dispense more than a one- or three-month quantity at a time. See below for billing frequencies. DME Provider Response: suggest following Medicare requirements as indicated. In particular following the policy "timely documentation is defined as a record in the preceding 12 months unless otherwise specified elsewhere in this policy". North Dakota Medicaid Response: Medicare’s “timely” of 12 months preceding in medical records is not sufficient for the department’s requirement that a member needs to be seen by a prescribing practitioner to be evaluated to insure continued medical necessity annually.

The Department will continue to require a member to be seen by their practitioner 60 days within the service authorization start date, but effective November 1st new revised to allow 90 days from the service authorization start date.

16. Page 12

Prescription/Order Direction of use; and DME Provider Response: Suppliers understand this is not a revised requirement BUT would like consideration on removing directions of use on all orders and limiting it to orders for supplies, products which are prescribed for a designated period of time, and/or drug related orders. To require the Provider to list directions of use for a commode, hospital bed, walker, etc. is in their words "redundant".

North Dakota Medicaid Response: The prescription section will be revised the “direction of use” element is required for all non-equipment items.

17. PRACTITIONER NOTE

For DMEPOS item(s) that require service authorization, the member must have been seen/examined within 60 days prior to the DMEPOS item(s) service authorization start date. For DMEPOS items that do not require a service authorization, the member must have been seen/examined within 60 days prior to the DMEPOS item (s) being initially delivered. DME Provider Response: Suppliers suggest following the ACA's (Affordable Care Act) requirement for certain DMEPSO items to be seen/examined within 6 months prior to delivery. (This would include most every item which requires a service auth requirement. The 60 day requirement would be removed. For items not requiring a service auth, suppliers request to change the 60 day requirement to 6 months.) Please see this link for all the information: https://med.noridianmedicare.com/web/jddme/topics/affordable-care-act-face-to-face-and- detailed-written-order.

North Dakota Medicaid Response: The DME manual will be revised to allow 90 days prior to the service authorization request start date to match 90 day timely filing to allow more time for members to be seen by their practitioner and DME providers additional time to obtain required documents.

18. Page 14

VERBAL ORDER/PRESCRIPTION

• The verbal dispensing order must include all required elements for an order/prescription. • If a verbal order is used for dispensing a DMEPOS item, the provider must obtain a written signed and dated order from the prescribing practitioner prior to the delivery of a DMEPOS item. DME Provider Response: Suppliers suggest removing this section. This verbiage states verbal orders cannot be used for dispensing until the prescribing practitioner signs it. This defeats the purpose of a verbal order. North Dakota Medicaid Response: Verbal order section will be removed as requested by the DME providers, but providers are still required to obtain a signed completed prescription from the prescribing practitioner prior to submitting a service authorization request or to claims for payment.

19. A CMN must be signed and dated by the prescribing practitioner within 60 days of the service authorization start date for it to be valid.

DME Provider Response: Suppliers suggest this be changed to 90 days. Currently 90 days are allowed to submit a service authorization from the date of service. The CMN time limit should be consistent with the Service Authorization time limit. North Dakota Medicaid Response: The DME manual will be revised to allow 90 days to match the 90 day filing and the practitioner note to allow more time for members to be seen by their practitioner and DME providers additional time to obtain required documents.

20. Page 18 If the expense for the equipment repair(s) exceeds 75% of the estimated expense of the

replacement cost, the DMEPOS provider will need to submit a service authorization request for replacement of the item(s). See replacement section for more details.

DME Provider Response: Suppliers feel providing details on all potential expenses and unseen problems is unrealistic when needing to replace equipment. Medicare has a RUL of five years. They still need justification to replace, but do not require detail list of all that is wrong with the pieces of equipment.

North Dakota Medicaid Response: Replacement is based on 1. Repairs or modifications do not exceed 75% replacement cost of the equipment. 2. The member has a change in condition that their current equipment is not able to be modified to meet their functional needs.

The detailed list is necessary to show why repairing/replacing with the allowed reimbursable fee to assist the provider to show repairs/replacement total cost exceeds 75%. Why replace an expensive powered wheelchair just because it reaches the RUL if needs new tires, motors, and cushions when it isn’t 75% of replacement cost of the chair?

21. Payment for repairs is not covered, when 'The skill of a technician is not required"

DME Provider Response: Suppliers suggest removing this statement. Suppliers should be reimbursed for repair/labor they provide to a ND Medicaid client so their equipment can be maintained properly. North Dakota Medicaid Response: When a member/caregiver can repair/replace an item a “skill technician is not necessary.

22. Page 20

Service authorization requests submitted for items included in the Non-Covered No Exception policy will be voided. A denial will not be issued as the Department cannot and will not allow a service authorization request solely for a denial in order to receive payment from another source. Instead, provide the alternative payer with documentation supporting the non-coverage of the item (Provider manuals, Department notices and/or bulletins. DME Provider Response: Currently if the primary pays for an item considered non-covered by Medicaid, it is denied as CO (contractual) by the State. Suppliers request for this denial code to be changed to a PR (patient responsibility) denial. The client knows up front that the item will be non-coved by the state and has chosen to receive it anyway. Provider please send TCNs related to this issue so we can look into this. DME Provider Response for clarification: The question was as follows: Currently, if the primary pays for an item considered non-covered by Medicaid, it is denied as

CO. Suppliers request for this denial code to be changed to PR denial. The client knows up front that the item will be non-covered by the state and has chosen to receive it anyway. North Dakota Medicaid Response: This same issue as in question 3. Department reviewed the submitted claims and will be making updating MMIIS as all non-covered items should being denied with PR denial code “patient responsibility" instead of CO “contractual obligation”.

23. Page 24 The servicing DMEPOS provider is required to submit the SA via the MMIS web portal prior to delivery. DME Provider Response: Previously the rule has been to submit the Service Authorization within 90 days of DOS. Suppliers suggest for the Dept. to consider how this will impact companies and affect staff who work weekends and holidays. Most are not trained to submit documentation of this type or trained to use the MMIS system. The Dept. also needs to clarify how clients who have coverage backdated such as a baby receiving bilirubin lights, apnea monitors, etc. will be handled. North Dakota Medicaid Response: allows 90 days to ensure that member’s receive their items in a timely manner. Providers can supply the item prior to submitting a service auth. request but the Department reminds providers that they are liable if they do not obtain approval. For infants with back dated eligibility the provider can utilize the same method that they currently use when a Medicare member becomes Medicaid eligible. Provider needs to write a note in the SA notes section the member’s eligibility date for consideration.

24. DMEPOS providers can check the status of the SA submitted on the MMIS web portal at any time. DME Provider Response: Currently when a Service Auth. denies suppliers are not able to see

the reason for the denial. The only information provided is a code of A3. This means they have to call the call center to find the reason. The State also has 30 days to respond to a Supplier so we may not receive a call back from the State for several days.

DME Provider Response: Suppliers suggest the reason for the authorization denial be available in the portal. This will be a significant cost saving for both the state and the supplier just by reducing the number of telephone inquiries. It will also be a much more efficient way to assure proper follow up on all our timely documentation requirements.

North Dakota Medicaid Response: As of the middle of June the notification letters sent to both

the member and provider has a text box that has the denial reason, or any pertinent information related to the service auth. The Call Center can assist the provider if additional clarification is needed.

Quick Reference

Links Comments from providers:

• Would like to keep the Quick Links. It would be fantastic if the fee allowables could be listed in the Quick Reference Guide.

• Please do not take these away. They are so handy.

• The reference links are a great clarification on what's needed and a great tool for Providers and

staff.

• The links are so time saving rather than paging through the manual.

• Please keep the Quick Reference Links. Much easier to update. If the policies are put back in

the manual the entire manual will need to be downloaded every time there is a change.

• Do not take the Reference Links away. Much easier to read and understand.

• Links are a very useful tool. The revision date is a wonderful resource when there is a change.

Other Concerns 1. Stander Policy: Covered for ages 0-21 and only 1 stander allowed every 10 years

Providing a stander to a 1 year old will last only about a year (due to growth). Suppliers request for the state to look at the age they will be required for and also look at a RUL of 7 years.

Replacement section states will consider replacing when a member has a change in condition and growth would meet this. Documentation to receive a stander is required from a PT/OT. This will be hard to come by since the state does not reimburse a PT/OT for their evaluations. Many are refusing to do these. North Dakota Medicaid Response: Providers please send TCN examples so we can review these denials? DME Provider Response: ask for this to clarification to be removed as there was PT/OT education provided via the Provider’s Updates.

2. Manual Wheelchair Policy: The comments done on this policy state seating evaluation done by a

professional. DME Provider Response: suppliers request this be clarified to say who? ATP, PT,OT? DME Provider Response: suppliers request clarification as needed on what type of documentation that will be required.

North Dakota Medicaid Response: Will use Medicare’s following verbiage: There is a comprehensive written evaluation by a licensed/certified medical professional, such as a physical therapist (PT) or occupational therapist (OT), which clearly explains why a prefabricated seating system is not sufficient to meet the beneficiary’s seating and positioning needs. The PT or OT may have no financial relationship with the supplier.

3. Home Assessment-Only needed if requested. Suppliers request more information on this.

DME Provider Response: What does this mean? Is this a requirement? When will it be requested?

North Dakota Medicaid Response: Provider please review the new Manual and Power Wheelchair policy that was sent to Barb/Kevin to share as not posted to the Quick Reference yet. See Screen shot highlighted section as states needs documented assessment is needed to insure it can accommodate the wheelchair being requested.

4. Bilirubin Light Policy: States covered for up to 7 days. DME Provider Response: Currently approvals are granted by the number of days listed on the prescription and if there is no n u m b e r of days listed the approval is denied. This should be listed in the policy. North Dakota Medicaid Response: The length of need is a required element for all prescriptions to prevent the service auth. from being denied. If the Prescription requests more than the 7 days and the SA requested units is more the SA will only be approved for 7 units only.

5. 02 Policy: States that the state follows Medicare coverage and rental guidelines. Under the

Documentation Requirement Section, it states A CMN is required for the initial order and recertification is required for month 13 and then yearly. The submitted CMN must have the 02 saturation documented and the oxygen saturation measurement must be within the last 30 days of the initial certification and re-certification. DME Provider Response: Suppliers request this be reworded and/or clarified. If the State follows Medicare guidelines no testing is required for the recertification. The client only needs to be seen by the Provider and the original testing is used on the CMN.

Currently the State approves 02 authorizations for 36 months. We request clarification on why a supplier would be required to submit documentation on month 13.

North Dakota Medicaid Response: The Department will be reviewing the rental guidance and related information on dual eligible members will update providers when a decision has been made.

6. O2 policy - Accessories and Supplies:

Policy states: The provider must provide any accessory ordered by the practitioner.

DME Provider Response: Suppliers request that this be reworded. A supplier should not have to provide products that are not medically necessary just because they are ordered. Examples would be specialty carry bags, extra batteries, etc. North Dakota Medicaid Response: Will revise to read. “The provider must provide policy covered accessory/accessories as ordered by the practitioner.