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Elizabeth M. Whitehorn, Director

Provider Notice issued 09/11/13

Prior Approval Policy Change for All Wheelchair and Power-Operated Vehicle (POV) Repairs Effective with Dates of Service on and after July 22, 2013

To:​ Enrolled Durable Medical Equipment and Supplies (DME) Providers; Pharmacies; Long Term Care Facilities; and Supportive Living Facilities​
Date:​ September 11, 2013​
Re:​ Prior Approval Policy Change for All Wheelchair and Power-Operated Vehicle (POV) Repairs Effective with Dates of Service on and after July 22, 2013 ​

This notice informs durable medical equipment (DME) providers of a change in state law affecting prior approval requirements for wheelchair repairs.

 

In the May 7, 2013 informational notice, Prior Approval Required for All Wheelchair and Power-Operated Vehicle (POV) Repairs Effective June 1, 2013, the department outlined prior approval policy mandated by Public Act 097-0689 (pdf). This Act, referred to as the Save Medicaid Access and Resources Together (SMART) Act, required prior approval for all wheelchair repairs. Recent legislation, Public Act 098-0104, modified the SMART Act policy to only require prior approval for wheelchair repairs when charges exceed $400.00.

Policy mandating prior approval for all wheelchair repairs was effective with dates of service beginning June 1, 2013. Public Act 098-0104 amending that policy was signed into law on July 22, 2013. 

  • For dates of service June 1 through July 21, 2013, providers are still required to obtain prior approval and bill accordingly.

  • For dates of service beginning July 22, 2013, prior approval is only required when the charges for the wheelchair repair exceed $400.00.

Per Public Act 098-0104, DME providers may not break wheelchair repairs into separate claims for purposes of staying under the $400.00 threshold. HFS will be monitoring DME billed claims for compliance on this issue.

Any questions regarding this notice may be directed to a DME billing consultant in the Bureau of Comprehensive Health Services at 1-877-782-5565, option 3, then option 2.

  

Theresa A. Eagleson, Administrator

Division of Medical Programs