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MassHealth Durable Medical Equipment (DME) Regulation And Deferred Compliance (Revised from 9/06/21)

September 13, 2021

Effective August 6, 2021, 130 CMR 409.000: Durable Medical Equipment Services was updated. In response to public comments, MassHealth revised 130 CMR 409.416(B)(4) to require the ordering practitioner’s unique National Provider Identifier (NPI) rather than the ordering practitioner’s address.

Please note that MassHealth is extending time for compliance with the provision requiring the ordering practitioner’s NPI, to allow DME/Oxygen and Respiratory Therapy Equipment (OXY) providers and ordering practitioners time to implement system updates. MassHealth will accept either the NPI number or the ordering practitioner’s address on a prescription or Letter of Medical Necessity (LOMN), together with all other required information, through September 30, 2021. Beginning October 1, 2021, the NPI number and all additional information will be required. If this information is missing on a prescription submitted with a prior authorization (PA) request, the PA request may be denied.

The full text of 130 CMR 409.416(B): Requirements for Prescriptions or Letters of Medical Necessity Completed by the Ordering Practitioner is below:

(B) The initial and subsequent prescriptions or the LOMN must contain the following information, as applicable, with the exception of item (5), which may be provided in additional supporting documentation:
(1) the member’s name;
(2) the date of the prescription;
(3) the name and quantity of the prescribed item and the number of refills (if appropriate);
(4) the name, NPI number, and signature of the ordering practitioner and date signed;
(5) medical justification for the item(s) being requested, including diagnosis or ICD-10 code;
(6) the equipment settings, hours to be used per day, options, or additional features, as they pertain to the equipment;
(7) length of need;
(8) the expected outcome and therapeutic benefit of providing the requested item(s) or treatment, when requested; and
(9) a summary of any previous treatment plan, including outcomes, that was used to treat the diagnosed condition for which the prescribed treatment is being recommended, upon request.

If you have questions, please contact the LTSS Provider Service Center at (844) 368-5184 or support@masshealthltss.com